First results on the effectiveness of various shortened standard or modified treatment regimens for patients with multidrug-resistant tuberculosis

Objеctive — to learn the effectiveness of various shortened standard or modified treatment regimens for patients with multidrug­resistant tuberculosis. Materials and methods. A prospective observational study was carried out to study different shortened AMBT regimens for 346 patients with multidrug-resistant tuberculosis treated during 2017—2020 years with different shortened (standard and modified) regimens of antimycobacterial therapy: group 1 (72 patients) 4ZEAmMfxCfzPtHhd 5ZEMfxCfz; Group 2 (123 patients) 6ZMfxLzdCmCs 6ZMfxLzdCs; Group 3 (81 patients) 6BdqLzdLfxCfzCs 3BdqLzdLfx; Group 4 (70 patients) (6BdqLzdMfxhdCs 3BdqLzdMfxhd). Results and discussion. At the time of treatment completion, «treatment success» was obtained in all patients who received the modified shortened regimens, compared with 72.5 % patients who received the standard short regimen recommended by the WHO (p < 0.05). Among the modified shortened regimens, 9-months regimens are the same in effectiveness as 12-month regimens, and also none of the regimens led to relapse.Both 9-month modified reduced regimens, that were studied, were equally effective: the cessation of bacterial excretion took place in all patients on (41.8 ± 3.2) days versus (38.9 ± 3.2) days. Tolerability of treatment was significantly better among patients receiving a treatment regimen with moxifloxacin compared with levofloxacin and clofazimine (p < 0.05): the total number of adverse reactions was recorded in 30.0 patients versus 64.2 %, the number of adverse reactions 3—4 degree of severity was the same between the comparison groups. Conclusions. To achieve the WHO targets, MDR-TB patients need to use modified shortened courses of treatment, because of their significantly better efficacy than the standard short-term regimen recommended by WHO. Because of duration of treatment and the same efficacy, 9-month modified shortened treatment regimens (with bedaquiline) are more acceptable for use than 12-months regimens (without bedaquiline).Given the safety profile, the priority for use is a 9-month modified shortened regimen with bedaquiline, linezolid, cycloserine and additionally high-dosed moxifloxacin, compared to a regimen that additionally includes levofloxacin and clofazimine.