Treatment for radiographically active, sputum culture-negative pulmonary tuberculosis: A systematic review and meta-analysis.
<h4>Background</h4>People with radiographic evidence for pulmonary tuberculosis (TB), but negative sputum cultures, have increased risk of developing culture-positive TB. Recent expansion of X-ray screening is leading to increased identification of this group. We set out to synthesise th...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2023-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0293535&type=printable |
| _version_ | 1797266396441214976 |
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| author | Adam Thorburn Gray Liana Macpherson Ffion Carlin Bianca Sossen Alexandra S Richards Sandra V Kik Rein M G J Houben Peter MacPherson Matteo Quartagno Ewelina Rogozińska Hanif Esmail |
| author_facet | Adam Thorburn Gray Liana Macpherson Ffion Carlin Bianca Sossen Alexandra S Richards Sandra V Kik Rein M G J Houben Peter MacPherson Matteo Quartagno Ewelina Rogozińska Hanif Esmail |
| author_sort | Adam Thorburn Gray |
| collection | DOAJ |
| description | <h4>Background</h4>People with radiographic evidence for pulmonary tuberculosis (TB), but negative sputum cultures, have increased risk of developing culture-positive TB. Recent expansion of X-ray screening is leading to increased identification of this group. We set out to synthesise the evidence for treatment to prevent progression to culture-positive disease.<h4>Methods</h4>We conducted a systematic review and meta-analysis. We searched for prospective trials evaluating the efficacy of TB regimens against placebo, observation, or alternative regimens, for the treatment of adults and children with radiographic evidence of TB but culture-negative respiratory samples. Databases were searched up to 18 Oct 2022. Study quality was assessed using ROB 2·0 and ROBINS-I. The primary outcome was progression to culture-positive TB. Meta-analysis with a random effects model was conducted to estimate pooled efficacy. This study was registered with PROSPERO (CRD42021248486).<h4>Findings</h4>We included 13 trials (32,568 individuals) conducted between 1955 and 2018. Radiographic and bacteriological criteria for inclusion varied. 19·1% to 57·9% of participants with active x-ray changes and no treatment progressed to culture-positive disease. Progression was reduced with any treatment (6 studies, risk ratio [RR] 0·27, 95%CI 0·13-0·56), although multi-drug TB treatment (RR 0·11, 95%CI 0·05-0·23) was significantly more effective than isoniazid treatment (RR 0·63, 95%CI 0·35-1·13) (p = 0·0002).<h4>Interpretation</h4>Multi-drug regimens were associated with significantly reduced risk of progression to TB disease for individuals with radiographically apparent, but culture-negative TB. However, most studies were old, conducted prior to the HIV epidemic and with outdated regimens. New clinical trials are required to identify the optimal treatment approach. |
| first_indexed | 2024-03-08T00:14:42Z |
| format | Article |
| id | doaj.art-f66c53023b434b0996955bb5dd23cc5c |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-25T01:00:02Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-f66c53023b434b0996955bb5dd23cc5c2024-03-11T05:32:30ZengPublic Library of Science (PLoS)PLoS ONE1932-62032023-01-011811e029353510.1371/journal.pone.0293535Treatment for radiographically active, sputum culture-negative pulmonary tuberculosis: A systematic review and meta-analysis.Adam Thorburn GrayLiana MacphersonFfion CarlinBianca SossenAlexandra S RichardsSandra V KikRein M G J HoubenPeter MacPhersonMatteo QuartagnoEwelina RogozińskaHanif Esmail<h4>Background</h4>People with radiographic evidence for pulmonary tuberculosis (TB), but negative sputum cultures, have increased risk of developing culture-positive TB. Recent expansion of X-ray screening is leading to increased identification of this group. We set out to synthesise the evidence for treatment to prevent progression to culture-positive disease.<h4>Methods</h4>We conducted a systematic review and meta-analysis. We searched for prospective trials evaluating the efficacy of TB regimens against placebo, observation, or alternative regimens, for the treatment of adults and children with radiographic evidence of TB but culture-negative respiratory samples. Databases were searched up to 18 Oct 2022. Study quality was assessed using ROB 2·0 and ROBINS-I. The primary outcome was progression to culture-positive TB. Meta-analysis with a random effects model was conducted to estimate pooled efficacy. This study was registered with PROSPERO (CRD42021248486).<h4>Findings</h4>We included 13 trials (32,568 individuals) conducted between 1955 and 2018. Radiographic and bacteriological criteria for inclusion varied. 19·1% to 57·9% of participants with active x-ray changes and no treatment progressed to culture-positive disease. Progression was reduced with any treatment (6 studies, risk ratio [RR] 0·27, 95%CI 0·13-0·56), although multi-drug TB treatment (RR 0·11, 95%CI 0·05-0·23) was significantly more effective than isoniazid treatment (RR 0·63, 95%CI 0·35-1·13) (p = 0·0002).<h4>Interpretation</h4>Multi-drug regimens were associated with significantly reduced risk of progression to TB disease for individuals with radiographically apparent, but culture-negative TB. However, most studies were old, conducted prior to the HIV epidemic and with outdated regimens. New clinical trials are required to identify the optimal treatment approach.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0293535&type=printable |
| spellingShingle | Adam Thorburn Gray Liana Macpherson Ffion Carlin Bianca Sossen Alexandra S Richards Sandra V Kik Rein M G J Houben Peter MacPherson Matteo Quartagno Ewelina Rogozińska Hanif Esmail Treatment for radiographically active, sputum culture-negative pulmonary tuberculosis: A systematic review and meta-analysis. PLoS ONE |
| title | Treatment for radiographically active, sputum culture-negative pulmonary tuberculosis: A systematic review and meta-analysis. |
| title_full | Treatment for radiographically active, sputum culture-negative pulmonary tuberculosis: A systematic review and meta-analysis. |
| title_fullStr | Treatment for radiographically active, sputum culture-negative pulmonary tuberculosis: A systematic review and meta-analysis. |
| title_full_unstemmed | Treatment for radiographically active, sputum culture-negative pulmonary tuberculosis: A systematic review and meta-analysis. |
| title_short | Treatment for radiographically active, sputum culture-negative pulmonary tuberculosis: A systematic review and meta-analysis. |
| title_sort | treatment for radiographically active sputum culture negative pulmonary tuberculosis a systematic review and meta analysis |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0293535&type=printable |
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