Elsevier

Tuberculosis

Volume 95, Issue 4, July 2015, Pages 490-496
Tuberculosis

Epidemiology
Moxifloxacin plus standard first-line therapy in the treatment of pulmonary tuberculosis: A meta-analysis

https://doi.org/10.1016/j.tube.2015.03.014Get rights and content

Summary

The fluoroquinolone moxifloxacin has potent activity against Mycobacterium tuberculosis and has been recommended by the guidelines for the treatment of pulmonary tuberculosis (TB). Monotherapy is not recommended by the guidelines and only a few studies have evaluated the efficacy and safety of moxifloxacin plus standard first-line therapy in treating TB. The purpose of this meta-analysis was to further investigate the efficacy and safety of moxifloxacin plus standard therapy compared with standard therapy alone in treating patients with pulmonary TB. Medline, Cochrane, EMBASE and Google Scholar (until February 12, 2015) were searched for studies that evaluated the clinical efficacy and tolerability of moxifloxacin in the treatment of pulmonary TB. Rate of culture conversion and serious adverse events (SAEs) were assessed. Risk of bias and sensitivity analysis, using the leave-one-out approach, was used to assess the robustness of the findings. Six studies were included in the meta-analysis which covered 2056 patients with pulmonary TB. For all included studies, the drug regimens at least contained rifampicin and pyrazinamide and the length of treatment was at least eight weeks. The odds ratio (OR) for the negative culture rate for moxifloxacin plus first-line medications compared first-line medications alone (the control group) was 1.60 with 95% CI in 0.93–2.74 (P = 0.089), indicating the moxifloxacin plus first-line medications had no significantly greater rate of culture conversion compared with first-line medication alone. The odds ratio of SAEs for moxifloxacin plus first-line medications compared with first-line medications alone found no difference in rate of SAEs between treatment groups (OR = 0.94, P = 0.862). In conclusion, our meta-analysis suggests that there was a trend for the addition of moxifloxacin to standard first-line therapy for non-drug resistant TB resulted to increase the rate of culture conversion but this effect requires confirmation in more randomized control trials.

Introduction

Tuberculosis (TB) is the second greatest cause of death from infectious disease across the world [1]. There were about 9 million new cases of TB and 1.6 million deaths in 2005 with the greatest burden being in developing countries [2], [3]. It is a high global health priority to develop new drugs and treatment regimens for TB [4].

In the United States, greater than 98% of patients treated for TB from n 1993 and 2007 had drug-susceptible strains [5]. The standard treatment for drug-susceptible TB is based on empirical observations of the efficacy and safety of different treatment regimens. The backbone of therapy is still isoniazid, rifampin, and pyrazinamide, although fluoroquinolones are being investigated as a replacement for isoniazid. This standard therapy is > 20 years old, and there has been an increase with multidrug resistant (MDR) and extensively drug-resistant (XDR) TB [6].

The fluoroquinolone moxifloxacin has potent activity against Mycobacterium. tuberculosis and has been recommended by the guidelines for the treatment of TB [7], [8]. Monotherapy is not recommended by the guidelines and only a few studies have evaluated the efficacy and safety of moxifloxacin plus standard therapy in treating TB [9]. The purpose of this meta-analysis was to further investigate the efficacy and safety of moxifloxacin plus standard therapy compared with standard therapy alone in treating patients with TB.

Section snippets

Methods

Medline, Cochrane, EMBASE and Google Scholar (until February 12, 2015) were searched for studies that evaluated the clinical efficacy and tolerability of moxifloxacin in the treatment of pulmonary tuberculosis. Key search terms included Mycobacterium tuberculosis, pulmonary tuberculosis, moxifloxacin

Studies were included if they were randomized controlled trials or two arm prospective studies. Studies had to have included patients with newly diagnosed pulmonary TB or sputum smears positive for

Literature search and study characteristics

Of the 224 studies identified in the search, 214 were eliminated for not being relevant (Figure 1). Six of the remaining 10 studies were subsequently removed for not including the intervention of interest. Six studies were included in the meta-analysis [13], [14], [15], [16], [17], [18].

One prospective study and 5 randomized controlled trials were included in this meta-analysis (Table 1). There were a total of 2056 patients with pulmonary TB. All participants were ≥18 years of age and the

Discussion

Our meta-analysis evaluated the rate of negative M. tuberculosis cultures in patients with TB following treatment with either the fluoroquinolone moxifloxacin plus first-line standard treatment or first-line standard treatment alone. We observed that moxifloxacin plus first-line medications did not have significantly higher rate of culture conversion than first-line medications alone. There was no difference between treatment groups in the rate of SAEs indicating addition of moxifloxacin to

Funding

This study was supported by National 12th Five-year special grand project for infectious diseases (2012ZX10003009).

Competing interests

None declared.

Ethical approval

Not required.

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