Burman 2006.
Methods | Trial design: multicentre RCT Follow‐up: 8 weeks Adverse event monitoring: not described Inclusion of all randomized participants in the final analysis: 59/336 (17.6%) excluded from final analysis |
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Participants | Number: 336 randomized; 277 evaluated Inclusion criteria: aged 18 years or older with suspected pulmonary TB and acid‐fast bacilli in an expectorated sputum sample Exclusion criteria: history of > 7 days of a fluoroquinolone antibiotic or TB treatment within the previous 6 months; pregnancy or breastfeeding; initial sputum cultures negative for M. tuberculosis or resistance to rifampicin, fluoroquinolones, or pyrazinamide (patients whose isolates were resistant to isoniazid were included) |
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Interventions | Fluoroquinolone (moxifloxacin) substituted into regimen (replacing ethambutol) for 2 months (8 weeks), initial 2 weeks of daily therapy under "supervision" 1. Moxifloxacin (400 mg daily) orally plus basic regimen (5 days a week or thrice a week for both dosing regimens) for 2 months 2. Ethambutol (0.8 g ‐ 40 to 55 kg; 1.2 g ‐ 56 to 75 kg; 1.6 g ‐ 76 to 90 kg) daily orally 5 days a week or (1.2 g ‐ 40 to 55 kg; 2 g ‐ 56 to 75 kg; 2.4g ‐ 76 to 90 kg) thrice weekly for 2 months plus basic regimen Basic regimen: Isoniazid (300 mg), rifampicin (450 mg if ≤ 45 kg; 600 mg if > 45 kg), and pyrazinamide (1 g ‐ 40 to 55 kg; 1.5 g ‐ 56 to 75 kg; 2 g ‐ 76 to 90 kg) given orally 5 days a week for 2 months; or isoniazid (15 mg/kg, max dose 900 mg), rifampicin (450 mg if ≤ 45 kg; 600 mg if > 45 kg), and pyrazinamide (1.5 g ‐ 40 to 55 kg; 2.5 g ‐ 56 to 75 kg; 3 g ‐ 76 to 90 kg) given thrice weekly orally for 2 months |
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Outcomes | 1. Death from any cause: 1/169 versus 0/167 2. Sputum culture conversion at 8 weeks: 99/169 versus 98/167 3. Serious adverse events: 10/169 versus 8/167 |
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Notes | Location: North America and Africa Setting: not described HIV status: HIV‐positive participants (30/169 ‐ fluoroquinolones + HRZ group, 30/167 ‐ control HRZE group) Resistance: isoniazid resistance (15/169 ‐ fluoroquinolones + HRZ group, 10/167 ‐ control HRZE group); 11 participants with resistance to rifampicin, fluoroquinolone or pyrazinamide ‐ excluded from analysis Dates: no mention in the trial report Funding: the US CDC. Bayer Pharmaceuticals donated moxifloxacin and moxifloxacin placebo tablets. Two of 12 authors had a financial relationship with the commercial entity that had an interest in the subject of the manuscript. |
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Risk of bias | ||
Bias | Authors' judgement | Support for judgement |
Random sequence generation (selection bias) | Unclear risk | "randomised in a factorial design"; "Randomisation was stratified by continent of enrolment and presence of pulmonary cavitation". |
Allocation concealment (selection bias) | Unclear risk | Method of concealment not described. |
Blinding of participants/personnel (efficacy outcomes);performance bias All outcomes | Low risk | Not described in study report. However the trial was double‐dummy placebo controlled. Review authors judged that the efficacy outcomes were not likely to be influenced by lack of blinding. |
Blinding of participants/personnel (safety outcomes);performance bias All outcomes | Low risk | Not described in study report. However the trial was double‐dummy placebo controlled. Review authors judged that the safety outcomes were not likely to be influenced by lack of blinding. |
Blinding of outcome assessment (efficacy outcomes);detection bias All outcomes | Low risk | Not described in the study report. However the trial was double‐dummy placebo controlled and outcome assessment for bacteriological outcomes was independent and almost certainly blinded. |
Blinding of outcome assessment (safety outcomes);detection bias | Low risk | Not described in the study report. However the trial was double‐dummy placebo controlled so safety outcomes were not likely to have been influenced by lack of blinding. |
Incomplete outcome data (attrition bias) All outcomes | High risk | 59/336 (17.6%) excluded from final analysis. Quote: "we excluded (1) patients who took non study therapy or required more than 70 days to complete the intensive phase, (2) patients who died during the intensive phase of therapy, and (3) patients whose sputum cultures were overgrown with bacteria or yeast. Patients who received at least one dose of study drug were included in the safety analysis". |
Selective reporting (reporting bias) | Unclear risk | Insufficient information to permit judgement |
Other bias | Unclear risk | Two of 12 authors had a financial conflict of interest. Bayer Pharmaceuticals donated moxifloxacin and moxifloxacin placebo tablets. |