EpidemiologyMoxifloxacin plus standard first-line therapy in the treatment of pulmonary tuberculosis: A meta-analysis
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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Cited by (14)
Short-course Regimen for Subsequent Treatment of Pulmonary Tuberculosis: A Prospective, Randomized, Controlled Multicenter Clinical Trial in China
2018, Clinical TherapeuticsCitation Excerpt :The study was designed based on the current interest in the role of quinolones in shortening TB treatment duration and the encouraging results from an earlier clinical trial for treatment of smear-positive patients with pulmonary TB with a 4-month ofloxacin-containing regimen.9 Newer fluoroquinolones have more potent bactericidal and sterilizing activities against mycobacteria, and moxifloxacin has produced excellent activity and favorable safety profiles,10–14 suggesting that it may prove useful in shortening the treatment duration for TB. Rifabutin is a derivative of rifamycin, which has higher affinity to the β-subunit of the bacterial RNA polymerase than rifampin and therefore kept antibacterial activity against rifampin-resistant Mycobacterium tuberculosis (MTB) based on in vitro data.15–17
Moxifloxacin is an effective and safe candidate agent for tuberculosis treatment: a meta-analysis
2017, International Journal of Infectious DiseasesCitation Excerpt :Considering the efficacy and safety, it is speculated that the addition of moxifloxacin to the recommended regimen may be superior to the recommended regimen alone for the treatment of TB. A previous meta-analysis assessed the clinical outcomes of moxifloxacin plus standard first-line therapy for the treatment of pulmonary TB (Chen et al., 2015). The control group patients in that study were given the combination of Z, H, and R, with or without E, which was called the standard regimen; the case group patients were given this standard regimen plus moxifloxacin.
Drugs Used in Tuberculosis and Leprosy
2016, Side Effects of Drugs AnnualCitation Excerpt :Other studies reported that FQs increase the risk of aortic dissection and aortic aneurysm [41MC,42MC]. However, a meta-analysis that analyzed 2056 patients revealed no difference in the rate of serious adverse effects between moxifloxacin and other first-line medications [43M]. Similarly, a meta-analysis of observational studies disputed literature reports that suggested a higher risk of retinal detachment associated with FQ therapy [44M].
Chapitre 5: Le traitement de la tuberculose active
2023, Canadian Journal of Respiratory, Critical Care, and Sleep MedicineAltered drug exposures of first-line TB drugs in a moxifloxacin-containing treatment regimen
2022, International Journal of Tuberculosis and Lung Disease