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A High-throughput Compatible Assay to Evaluate Drug Efficacy against Macrophage Passaged Mycobacterium tuberculosis
Published on: March 24, 2017
Strategies for treating latent multiple-drug resistant tuberculosis: a decision analysis
David P Holland1, Gillian D Sanders, Carol D Hamilton
1Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America. david.p.holland@duke.edu
Plos One
|January 25, 2012
Summary
Moxifloxacin/ethambutol is the preferred treatment for latent multidrug-resistant tuberculosis (MDR-TB) infection. Pyrazinamide regimens showed poor outcomes due to toxicity, highlighting the need for better data on treatment side effects.
Area of Science:
- Infectious Diseases
- Pharmacoeconomics
- Mathematical Modeling
Background:
- Optimal treatment for latent multidrug-resistant tuberculosis (MDR-TB) infection is not well-defined.
- Modeling is crucial for anticipating clinical trial outcomes for latent MDR-TB regimens.
Purpose of the Study:
- To model the cost-effectiveness of six potential regimens for latent MDR-TB infection.
- To compare the performance of various drug combinations against latent MDR-TB.
Main Methods:
- A computerized Markov model was utilized to assess treatment costs.
- Six regimens were evaluated: Pyrazinamide/ethambutol, moxifloxacin monotherapy, moxifloxacin/pyrazinamide, moxifloxacin/ethambutol, moxifloxacin/ethionamide, and moxifloxacin/PA-824.
- Efficacy estimates were derived from mouse models and analyzed across diverse assumptions.
Main Results:
- Moxifloxacin monotherapy was the least costly regimen in the base-case scenario.
- Moxifloxacin/ethambutol demonstrated cost-effectiveness at an ICER of $21,252 per QALY.
- Pyrazinamide-containing regimens were found to be dominated due to significant toxicity.
Conclusions:
- Moxifloxacin/ethambutol emerged as the preferred treatment strategy across various assumptions.
- High toxicity rates of pyrazinamide-based regimens led to poor performance.
- Data on treatment toxicity and discontinuation are vital for public health practice in latent MDR-TB management.
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