Efficacy and safety of 6-month and 4-month anti-tuberculosis regimens: A review of literature and meta-analysis

Evidence on the efficacy and safety of a 4-month treatment regimen for tuberculosis have been reported in many countries. Our study evaluated the efficacy and safety of the newer 4-month treatment regimen relative to the traditional 6-month treatment regimen. We used review of literature to search and identity articles from various databases, comparing the 4-month and 6-month anti-TB treatment regimens. RCTs that were published in the English language from 2017-2022 that used drug susceptible TB adult patients were included in the final meta-analysis. We compared the efficacy and safety of the two regimens using Odds Ratio or Risk Ratio with 95% confidence intervals. Total of 5 studies were included out of 79 articles searched, screened, reviewed, and appraised. In terms of efficacy (n=7,047), random effect estimates showed OR =0.64 (95%CI:0.46–0.90) which is significant (p-value:0.009). The odds of being disease-free is 0.64 times experiencing the outcome in the 4-month compared with the 6-month anti-TB regimen. There was also high heterogeneity among the included studies (I2=77%;Chi2=13.27). In terms of safety (n=8,649), random effect estimates showed RR = 1.23 (95% CI:0.84–1.79)which is not significant (p-value: 0.28). This means that there is 1.23 times the risk of adverse events in the 4-month compared with the 6-month anti-TB regimen. It can also be seen that there was somewhat high heterogeneity among the included studies (I2=49%; Chi2 = 7.78). Our meta-analysis showed that the 4-month anti-TB regimen is superior in terms of efficacy than the 6-month treatment but both have comparable safety profile. This analysis showed promising results which may stilmulate further studies.