Impacts of clofazimine on the treatment outcomes of drug-resistant tuberculosis

Abstract

BackgroundThe purpose of this research was to evaluate the effect of clofazimine on drug-resistant tuberculosis treatment outcomes. MethodsA systematic search was conducted in the PubMed, Web of Science and EMBASE databases to identify eligible studies published up to July 10, 2021. The search terms were as follows: “clofazimine,” “tuberculosis,” “multidrug resistant tuberculosis” or “extensively drug resistant tuberculosis” and their synonyms or similar words. Two researchers independently screened the titles, abstracts, and full texts for inclusion. Meta-analysis was performed with Stata version 16.0 (Stata Corp., College Station, Texas, USA). Risk ratios (RRs) with 95% CIs were calculated to evaluate the treatment outcome. ResultsEight studies including 3219 participants were included in the meta-analysis. The meta-analysis found that the rates of treatment completion was higher in patients receiving clofazimine-containing regimens than in those not receiving clofazimine-containing regimens (RR: 1.185 (1.060–1.325), P = 0.003). Significant reduction in treatment failure (RR: 0.598 (0.473–0.756), P < 0.001) was found in the clofazimine treatment group. The subgroup analyses of randomized controlled trials (RCTs) found a higher rates of favorable outcomes, treatment completion and cure in the clofazimine group than in the control group (RR: 1.203 (1.029–1.407), P = 0.020; RR: 3.167 (2.043–4.908), P < 0.001; and RR: 1.251 (1.031–1.518), P = 0.023, respectively). Patients receiving clofazimine had a lower risk of treatment failure than those not receiving clofazimine (RR: 0.529 (0.454–0.616), P < 0.001). However, clofazimine treatment did not have a statistically significant effect on all-cause mortality in RCTs. ConclusionsThis study demonstrated that compared with patients who do not receive clofazimine, this drug has the potential to achieve a higher favorable outcome, treatment completion and cure rates, and a lower treatment failure risk among drug-resistant tuberculosis cases.