Results of traditional and new regimens of MDR/XDR TB treatment: cohort analysis

<b>Background:</b> The Moscow experience in new TB drugs implementation may be considered as real-life realization of some approaches declared in the new WHO initiative (2018, August). <b>Methods:</b> Based on the city personal register for MDR TB cases formed the aggregate cohort (1387 pts, adult, HIV-negative, started treatment in 2014 Jan – 2016 Dec), includes 294 pts on the core combination [Bdq Lnz Mox/Lev Cyclo] with 1-2 other drugs (“modern regimen” – MR) and 1093 pts on “optimized basic regimen” (OBR) by current WHO guidelines. To compare the outcomes after 18-24 months some sub-cohort were selected by various characteristics. <b>Results:</b> Totally, outcome “treatment success” (TS) registered after MR in 68.4% (95%CI 63.0-73.7%) and after OBR – in 51.9% (48.9-54.8%). The reliably benefits of MR proved in all sub-cohorts. TC rate on MR in new cases was 92.4% (87.6-97.2% in 134 pts) vs 66.0% (62.1-69.9% in 559 pts) on OBR, in relapses – respectively 71.7% (58.4-85.1% in 46 pts) and 52.4% (45.2-59.7% in 185 pts). In cases with previous outcome “treatment failure” TS on MR (in 114 pts) obtained in 51.8% (42.5-61.0%) vs 28.9% (24.2-33.7%) on OBR (in 349 pts). The TS rate of MR was higher both in cases with MDR-non-XDR (in 133 pts) – 72.2% (64.5-79.9%) vs 54.2% (50.8-57.6%) on OBR (in 838 pts) and XDR (in 162 pts) – 65.4% (58.1-72.8%) vs 39.6% (32.7-46.5%) on OBR (in 197 pts). The advantages of MR proved also in cases with cavitary lesions (TS 64.9%, 59.0-70.9% in 251 pts vs OBR 45.3%, 41.8-48.9% in 774 pts). <b>Conclusion:</b> The treatment regimen, based on the new approaches to their elaboration, are preferable in all groups of MDR/XDR TB patients.