Abstract
Multidrug resistant tuberculosis (MDR-TB) is a serious form of tuberculosis (TB). There is no recognized effective treatment for MDR-TB, although there are a number of publications that have reported positive results for MDR-TB. We performed a network meta-analysis to assess the efficacy and acceptability of potential antitubercular drugs. We conducted a network meta-analysis of randomized controlled clinical trials to compare the efficacy and acceptability of five antitubercular drugs, bedaquiline, delamanid, levofloxacin, metronidazole and moxifloxacin in the treatment of MDR-TB. We included eleven suitable trials from nine journal articles and six clinical trials from ClinicalTrials.gov, with data for 1472 participants. Bedaquiline (odds ratio [OR] 2.69, 95% CI 1.02-7.43), delamanid (OR 2.45, 95% CI 1.36-4.89) and moxifloxacin (OR 2.47, 95% CI 1.01, 7.31) were significantly more effective than placebo. For efficacy, the results indicated no statistical significance between each antitubercular drug. For acceptability, the results indicated no statistically significant difference between each compared intervention. There is insufficient evidence to suggest that any one of the five antitubercular drugs (bedaquiline, delamanid, levofloxacin, metronidazole and moxifloxacin) has superior efficacy compared to the others.Electronic supplementary materialThe online version of this article (doi:10.1186/s13336-015-0020-x) contains supplementary material, which is available to authorized users.
Highlights
Tuberculosis (TB) has tormented humans over the centuries and was a leading cause of death in Asia, Europe and North America for centuries [1,2]
The methodological quality of included trials was generally high
Our analysis was based on eleven clinical trials that included 1472 individuals who had been randomly assigned to five antituberculosis drugs used to treat multidrug resistance tuberculosis (MDR-TB)
Summary
Tuberculosis (TB) has tormented humans over the centuries and was a leading cause of death in Asia, Europe and North America for centuries [1,2]. The emergence of multidrug resistance tuberculosis (MDR-TB) and even extensively drug tuberculosis resistant (XDR-TB) is a major threat to global TB care and control. MDR-TB is caused by Mycobacterium tuberculosis that is resistant to at least isoniazid (INH) and rifampin (RMP). MDR-TB includes the subcategory of XDR-TB, which is MDR-TB with additional resistance to any fluoroquinolone and to at least one of three injectable anti-TB drugs [3]. The World Health Organization (WHO) estimates that about 450,000 new MDR-TB cases and about 170,000 MDRTB deaths have occurred across the world in 2012 [4]. The overall treatment duration is at least 18 months, and requires more
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