High rates of treatment success and favorable outcomes were achieved among women who received treatment for multidrug-resistant tuberculosis (MDR-TD) during pregnancy, according to results of a systematic review and meta-analysis published in JAMA Network Open.
Investigators at Curtin University in Australia searched publication databases through August 2021 for studies that assessed MDR-TB infections among women during pregnancy. The primary outcome were treatment success, death, loss to follow-up, and treatment failure; the secondary outcome was the number of patients who experienced an adverse event (AE) related to treatment during pregnancy.
A total of 10 studies comprising 288 patients with MDR-TB infection during pregnancy were included in this analysis. The studies were published between 2003 and 2021, and sample sizes ranged between 5 and 108 patients. The most common treatments included pyrazinamide, cycloserine, prothionamide, and fluoroquinolones.
Overall, the pooled rate of treatment success was 72.5% (95% CI, 63.3-81.0; I2 =44.7%; P =.06). Outcomes of death and treatment failure occurred among 6.8% (95% CI, 2.6-12.4; I2 =20.5%; P =.26) and 0.6% (95% CI, 0.0-2.9; P =.77) of patients, respectively, and 18.4% (95% CI, 13.1-24.2; P =.54) were lost to follow-up.
Treatment success rates were increased in patients whose site of MDR-TB infection was unknown (79.4%) compared with those with pulmonary TB infection (68.3%), as well as those with both pulmonary and extrapulmonary TB infection (63.5%). For studies that had an increased prevalence of HIV infection among the patient population, loss to follow-up was more likely to occur (odds ratio [OR], 1.11; 95% CI, 1.06-1.17). Loss to follow-up rates also were increased in studies that included patients aged between 26 and 30 years vs those that included patients between 21 and 25 years (OR, 1.11; 95% CI, 1.03-1.21). Medication regimens that included linezolid were associated with a significantly increased rate of treatment success (OR, 1.22; 95% CI, 1.05-1.42).
Overall, drug-related AEs were reported by 54.7% of the patients. The most common AEs were liver function impairment (30.4%), kidney impairment (14.9%), hypokalemia (11.9%), hearing loss (11.8%), and gastrointestinal disorders (11.8%).
Among all patients, favorable pregnancy outcomes occurred in 73.2%. The most common adverse pregnancy outcomes included preterm birth (9.5%), pregnancy loss (6.0%), low birth weight (3.9%), and stillbirth (1.9%).
Limitations included potential selection bias and that only 10 studies comprising less than 300 patients were assessed. This analysis also was underpowered to detect associations between study characteristics and treatment outcomes.
“Further research is needed to design shorter, more effective, and safer treatment regimens for pregnant patients with MDR-TB,” the researchers concluded.
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