Efficacy of chemotherapy and long-term treatment outcomes in patients with multidrug- and extensively drug-resistant tuberculosis with premature withdrawal of chemotherapy; Эффективность химиотерапии и отдалённые результаты лечения больных туберкулезом легких с множественной и широкой лекарственной устойчивостью возбудителя с преждевременной отменой химиотерапии

Introduction. The problem of mycobacterium tuberculosis resistance requires the effective implementation of a strategy to curb the growth of the pathogen’s drug resistance, namely, monitoring the competent administration of anti-tuberculosis drugs, and developing new chemotherapy regimens to improve the treatment efficacy. Aim. To study the long-term outcomes of shortened multidrug- and extensively drug-resistant pulmonary tuberculosis treatment regimens based on the analysis of the clinical course of the disease and the chemotherapy efficacy in patients who interrupted treatment for various reasons at earlier stages than provided for by official Clinical Recommendations. Materials and Methods. Chemotherapy efficacy and long-term treatment outcomes were analyzed retrospectively in 43 patients treated at CTRI in 2015-2021 and prematurely ceased the main chemotherapy cycle for various reasons. Inclusion criteria: Patients with the established and verified diagnosis of pulmonary tuberculosis, with or without any compensated concomitant pathology, and with the established bacterial excretion with multidrug- and extensively drug-resistant pulmonary tuberculosis. The study had a retrospective, analytical design. Therefore, it was not required to obtain approval from the local ethics committee. Study object: Medical and outpatient records of patients hospitalized and examined in the consulting department after discharge from the hospital. Results and Discussion. The treatment efficacy indicator, according to the criterion of cessation of bacterial excretion after 6 months of chemotherapy, was 90.7%, i. e., 39/43 patients, and after 12 months the cessation of bacterial excretion was achieved in all patients (100%, i. e., 43/43 p.). Closure of the cavities was found in 38.1%, i. e., in 8/21 patients, after 6 months of treatment, andin 95.2%, i. e., 20/21 patients after 12 months. Conclusions. The main chemotherapy cycle continued for 6-9 months in 20.9% of cases, 9-12 months in 37.2% of cases, and 12-15 months in 41.9% of cases. Among the main reasons for premature discontinuation of chemotherapy, the largest share was the unauthorized cessation of treatment (29.8%) and the lack of necessary chemotherapy drugs in regional anti-tuberculosis institutions (25.5%). 12 months after completion of chemotherapy, no cases of relapse of tuberculosis were detected. By 24 months of observation, relapses of the disease were registered in 18.6% (8/43 patients). A study based on real clinical practice materials shows that complex treatment of patients with multidrug- and extensively drug-resistant pulmonary tuberculosis using modern chemotherapy drugs, including bedaquiline, in combination with the use of surgical methods allows achieving high rates of treatment efficacy even in conditions of the forced premature chemotherapy withdrawal and creates the prerequisites for further research in the shortened treatment regimens for patients with multidrug-resistant tuberculosis. © 2025 Elsevier B.V., All rights reserved.