Table 1.
Studies of fluoroquinolone-containing regimens used as basis for 2017 WHO DS-TB treatment guidelines update
REMoxTB | RIFAQUIN | OFLOTUB | |
---|---|---|---|
Control arm | HRZE × 8 weeks followed by HR × 18 weeks | HRZE × 8 weeks followed by HR × 16 weeks | HRZE × 8 weeks followed by HR × 16 weeks |
Experimental arms | Arm 1: HRZE × 8 weeks followed by HRM × 9 weeks Arm 2: MRZE × 8 weeks followed by RM × 9 weeks |
Arm 1: MRZE × 8 weeks followed by MPZE twice weekly × 8 weeks Arm 2: MRZE x weeks followed by MPZE once weekly × 16 weeks |
HRZG × 8 weeks followed by HRG × 8 weeks |
HIV eligibility criteria | PLWH already on ART and with CD4 < 250 cells/ml3 were ineligible N=110 PLWH (7%) enrolled; median CD4 not reported |
PLWH who required ART were initially ineligible; as the trial progressed, PLWH were eligible CD4 count < 200 cells/ml3 were initially ineligible, but this was subsequently amended to 150 cells/ml3 N=158 PLWH (27%) enrolled; median CD4 314 cells/ml (IQR 253–441 cells/ml3) |
PLWH with WHO stage 3 infection (except those presenting with only the loss of weight criterion) and all PLWH with WHO stage 4 infection were ineligible N=110 PLWH (7%) enrolled; median CD4 not reported |
Primary outcome | Unfavorable outcomes: Treatment failure or relapse within 18 months of randomization | Unfavorable outcomes: Treatment failure, relapse or death within 12–18 months of randomization | Unfavorable outcomes: Treatment failure, recurrence, study withdrawal or death within 24 months after end of treatment |
Secondary outcome | Grade 3 or 4 adverse events | Grade 3 or 4 adverse events | Serious adverse events |
Results | Unfavorable outcomes were more frequent in both experimental arms compared to the control arm. No significant difference in grade 3 or 4 adverse events between arms. No significant difference in 8 week culture conversion although both experimental arms had shorter time to culture conversion on solid and liquid media. |
The 6-month experimental arm was as effective as the control arm and the 4-month arm was not noninferior to the control arm with respect to unfavorable outcomes No significant difference in grade 3 or 4 adverse events between arms. |
The experimental arm was not noninferior to the control arm with respect to unfavorable outcomes No significant difference in serious adverse events between arms |
HIV subgroup analyses | No difference in unfavorable outcomes according to HIV status | No difference in unfavorable outcomes according to HIV status | Fewer unfavorable outcomes in the experimental group compared to the control group |
E, ethambutol; G, gatifloxacin; H, isoniazid; M, moxifloxacin; P, rifapentine; PLWH, people living with HIV; R, rifampin; Z, pyrazinamide.