Effective regimens ensure high rate of treatment success among pregnant women with MDR-TB: JAMA

Australia: In pregnant patients with multidrug-resistant tuberculosis (MDR-TB), effective treatment regimens can achieve a high rate of treatment success and favourable pregnancy outcomes, shows review data published in the JAMA Network Open.

Globally,multidrug-resistant tuberculosis( MDR-TB) is present in 3.8% of new TB patients and 20% of patients who have a history of previous treatment. Pregnant patients are particularly vulnerable to MDR-TB. A teratogenic effect of some of the second-line TB medications makes the management of MDR-TB among pregnant patients more challenging and complex.

The physiological dynamics of pregnancy might affect the drug's pharmacokinetic parameters, which could lead to inadequate treatment and poor outcomes. MDR-TB when not treated leads to significant maternal mortality, morbidity, and adverse pregnancy outcomes, still, there is no standardized regimen for treatment of MDR-TB among pregnant patients.

MDR-TB during pregnancy is challenging, yet no systematic synthesis of evidence has accurately measured treatment outcomes. Dr Kefyalew, Telethon Kids Institute, Australia and colleagues tried to systematically synthesize treatment outcomes and adverse events among pregnant patients with MDR-TB by a systematic review and meta-analysis of 10 studies including 275 pregnant patients with MDR-TB.

Investigators searched PubMed, Scopus, Web of Science, and ProQuest from the inception of each database through August 31, 2021. Studies containing cohorts of pregnant patients with a defined treatment outcome were eligible. Independent reviewers screened studies and assessed the risk of bias. The primary outcome was the proportion of patients with each treatment outcome (including treatment success, death, loss to follow-up, and treatment failure), and the secondary outcomes included the proportion of patients experiencing adverse events during pregnancy.

Key findings of the review,

• The pooled proportion of treatment success was 72.5%, and the pooled proportion of favourable pregnancy outcomes was 73.2%.

• Adverse events, such as liver function impairment, kidney function impairment, hearing loss, and hypokalemia, were common among pregnant patients with MDR-TB, occurring in more than half of the patients.

• The most common types of adverse pregnancy outcomes were preterm birth, pregnancy loss, low birth weight and stillbirth.

Investigators conclude that effective treatment regimens achieved high treatment success rates and favourable pregnancy outcomes in  pregnant patients with MDR-TB. They recommend further research to design shorter, more effective, and safer treatment regimens for pregnant patients with MDR-TB.

Reference:

Alene KA, Murray MB, van de Water BJ, et al. Treatment Outcomes Among Pregnant Patients With Multidrug-Resistant Tuberculosis: A Systematic Review and Meta-analysis. JAMA Netw Open. 2022;5(6):e2216527.

doi:10.1001/jamanetworkopen.2022.16527