Optimal duration of anti-TB treatment in patients with diabetes

Nine or six months?

Jann Yuan Wang, Ming Chia Lee, Chin Chung Shu, Chih Hsin Lee, Li Na Lee, Kun Mao Chao, Feng Yee Chang

研究成果: 雜誌貢獻文章

41 引文 (Scopus)

摘要

BACKGROUND: Diabetes mellitus (DM) increases the risk of TB recurrence. This study investigated whether 9-month anti-TB treatment is associated with a lower risk of TB recurrence within 2 years after complete treatment than 6-month treatment in patients with DM with an emphasis on the impact of directly observed therapy, short course (DOTs). METHODS: Patients with pulmonary but not extrapulmonary TB receiving treatment of 173 to 277 days between 2002 and 2010 were identified from the National Health Insurance Research Database of Taiwan. Patients with DM were then selected and classified into two groups based on anti-TB treatment duration (9 months vs 6 months). Factors predicting 2-year TB recurrence were explored using Cox regression analysis. RESULTS: Among 12,688 patients with DM and 43,195 patients without DM, the 2-year TB recurrence rate was 2.20% and 1.38%, respectively (P <.001). Of the patients with DM, recurrence rate decreased from 3.54% to 1.19% after implementation of DOTs (P <.001). A total of 4,506 (35.5%) were classified into 9-month anti-TB treatment group. Although a 9-month anti-TB treatment was associated with a lower recurrence rate (hazard ratio, 0.76 [95% CI, 0.59-0.97]), the benefit disappeared (hazard ratio, 0.69 [95% CI, 0.43-1.11]) under DOTs. Other predictors of recurrence included older age, male sex, malignancy, earlier TB diagnosis year, culture positivity after 2 months of anti-TB treatment, and anti-TB treatment being ≤ 80% consistent with standard regimen. CONCLUSIONS: The 2-year TB recurrence rate is higher in a diabetic population in Taiwan and can be reduced by treatment supervision. Extending the anti-TB treatment by 3 months may also decrease the recurrence rate when treatment is not supervised.

原文英語
頁(從 - 到)520-528
頁數9
期刊Chest
147
發行號2
DOIs
出版狀態已發佈 - 二月 1 2015

指紋

Recurrence
Diabetes Mellitus
Therapeutics
Taiwan
Directly Observed Therapy
National Health Programs
Early Diagnosis
Regression Analysis
Databases
Lung
Research
Population
funiferine N-oxide
Neoplasms

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

引用此文

Wang, J. Y., Lee, M. C., Shu, C. C., Lee, C. H., Lee, L. N., Chao, K. M., & Chang, F. Y. (2015). Optimal duration of anti-TB treatment in patients with diabetes: Nine or six months? Chest, 147(2), 520-528. https://doi.org/10.1378/chest.14-0918

Optimal duration of anti-TB treatment in patients with diabetes : Nine or six months? / Wang, Jann Yuan; Lee, Ming Chia; Shu, Chin Chung; Lee, Chih Hsin; Lee, Li Na; Chao, Kun Mao; Chang, Feng Yee.

於: Chest, 卷 147, 編號 2, 01.02.2015, p. 520-528.

研究成果: 雜誌貢獻文章

Wang, JY, Lee, MC, Shu, CC, Lee, CH, Lee, LN, Chao, KM & Chang, FY 2015, 'Optimal duration of anti-TB treatment in patients with diabetes: Nine or six months?', Chest, 卷 147, 編號 2, 頁 520-528. https://doi.org/10.1378/chest.14-0918
Wang, Jann Yuan ; Lee, Ming Chia ; Shu, Chin Chung ; Lee, Chih Hsin ; Lee, Li Na ; Chao, Kun Mao ; Chang, Feng Yee. / Optimal duration of anti-TB treatment in patients with diabetes : Nine or six months?. 於: Chest. 2015 ; 卷 147, 編號 2. 頁 520-528.
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title = "Optimal duration of anti-TB treatment in patients with diabetes: Nine or six months?",
abstract = "BACKGROUND: Diabetes mellitus (DM) increases the risk of TB recurrence. This study investigated whether 9-month anti-TB treatment is associated with a lower risk of TB recurrence within 2 years after complete treatment than 6-month treatment in patients with DM with an emphasis on the impact of directly observed therapy, short course (DOTs). METHODS: Patients with pulmonary but not extrapulmonary TB receiving treatment of 173 to 277 days between 2002 and 2010 were identified from the National Health Insurance Research Database of Taiwan. Patients with DM were then selected and classified into two groups based on anti-TB treatment duration (9 months vs 6 months). Factors predicting 2-year TB recurrence were explored using Cox regression analysis. RESULTS: Among 12,688 patients with DM and 43,195 patients without DM, the 2-year TB recurrence rate was 2.20{\%} and 1.38{\%}, respectively (P <.001). Of the patients with DM, recurrence rate decreased from 3.54{\%} to 1.19{\%} after implementation of DOTs (P <.001). A total of 4,506 (35.5{\%}) were classified into 9-month anti-TB treatment group. Although a 9-month anti-TB treatment was associated with a lower recurrence rate (hazard ratio, 0.76 [95{\%} CI, 0.59-0.97]), the benefit disappeared (hazard ratio, 0.69 [95{\%} CI, 0.43-1.11]) under DOTs. Other predictors of recurrence included older age, male sex, malignancy, earlier TB diagnosis year, culture positivity after 2 months of anti-TB treatment, and anti-TB treatment being ≤ 80{\%} consistent with standard regimen. CONCLUSIONS: The 2-year TB recurrence rate is higher in a diabetic population in Taiwan and can be reduced by treatment supervision. Extending the anti-TB treatment by 3 months may also decrease the recurrence rate when treatment is not supervised.",
author = "Wang, {Jann Yuan} and Lee, {Ming Chia} and Shu, {Chin Chung} and Lee, {Chih Hsin} and Lee, {Li Na} and Chao, {Kun Mao} and Chang, {Feng Yee}",
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T1 - Optimal duration of anti-TB treatment in patients with diabetes

T2 - Nine or six months?

AU - Wang, Jann Yuan

AU - Lee, Ming Chia

AU - Shu, Chin Chung

AU - Lee, Chih Hsin

AU - Lee, Li Na

AU - Chao, Kun Mao

AU - Chang, Feng Yee

PY - 2015/2/1

Y1 - 2015/2/1

N2 - BACKGROUND: Diabetes mellitus (DM) increases the risk of TB recurrence. This study investigated whether 9-month anti-TB treatment is associated with a lower risk of TB recurrence within 2 years after complete treatment than 6-month treatment in patients with DM with an emphasis on the impact of directly observed therapy, short course (DOTs). METHODS: Patients with pulmonary but not extrapulmonary TB receiving treatment of 173 to 277 days between 2002 and 2010 were identified from the National Health Insurance Research Database of Taiwan. Patients with DM were then selected and classified into two groups based on anti-TB treatment duration (9 months vs 6 months). Factors predicting 2-year TB recurrence were explored using Cox regression analysis. RESULTS: Among 12,688 patients with DM and 43,195 patients without DM, the 2-year TB recurrence rate was 2.20% and 1.38%, respectively (P <.001). Of the patients with DM, recurrence rate decreased from 3.54% to 1.19% after implementation of DOTs (P <.001). A total of 4,506 (35.5%) were classified into 9-month anti-TB treatment group. Although a 9-month anti-TB treatment was associated with a lower recurrence rate (hazard ratio, 0.76 [95% CI, 0.59-0.97]), the benefit disappeared (hazard ratio, 0.69 [95% CI, 0.43-1.11]) under DOTs. Other predictors of recurrence included older age, male sex, malignancy, earlier TB diagnosis year, culture positivity after 2 months of anti-TB treatment, and anti-TB treatment being ≤ 80% consistent with standard regimen. CONCLUSIONS: The 2-year TB recurrence rate is higher in a diabetic population in Taiwan and can be reduced by treatment supervision. Extending the anti-TB treatment by 3 months may also decrease the recurrence rate when treatment is not supervised.

AB - BACKGROUND: Diabetes mellitus (DM) increases the risk of TB recurrence. This study investigated whether 9-month anti-TB treatment is associated with a lower risk of TB recurrence within 2 years after complete treatment than 6-month treatment in patients with DM with an emphasis on the impact of directly observed therapy, short course (DOTs). METHODS: Patients with pulmonary but not extrapulmonary TB receiving treatment of 173 to 277 days between 2002 and 2010 were identified from the National Health Insurance Research Database of Taiwan. Patients with DM were then selected and classified into two groups based on anti-TB treatment duration (9 months vs 6 months). Factors predicting 2-year TB recurrence were explored using Cox regression analysis. RESULTS: Among 12,688 patients with DM and 43,195 patients without DM, the 2-year TB recurrence rate was 2.20% and 1.38%, respectively (P <.001). Of the patients with DM, recurrence rate decreased from 3.54% to 1.19% after implementation of DOTs (P <.001). A total of 4,506 (35.5%) were classified into 9-month anti-TB treatment group. Although a 9-month anti-TB treatment was associated with a lower recurrence rate (hazard ratio, 0.76 [95% CI, 0.59-0.97]), the benefit disappeared (hazard ratio, 0.69 [95% CI, 0.43-1.11]) under DOTs. Other predictors of recurrence included older age, male sex, malignancy, earlier TB diagnosis year, culture positivity after 2 months of anti-TB treatment, and anti-TB treatment being ≤ 80% consistent with standard regimen. CONCLUSIONS: The 2-year TB recurrence rate is higher in a diabetic population in Taiwan and can be reduced by treatment supervision. Extending the anti-TB treatment by 3 months may also decrease the recurrence rate when treatment is not supervised.

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