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Meta-Analysis
, 5 (2), e12

Moxifloxacin and Gatifloxacin for Initial Therapy of Tuberculosis: A Meta-Analysis of Randomized Clinical Trials

Meta-Analysis

Moxifloxacin and Gatifloxacin for Initial Therapy of Tuberculosis: A Meta-Analysis of Randomized Clinical Trials

Qiaoling Ruan et al. Emerg Microbes Infect.

Abstract

Moxifloxacin (MOX) and gatifloxacin (GAT) have exhibited promising mycobactericidal activity, and a number of clinical trials have been conducted in recent decades to compare the treatment efficacy of MOX-containing and/or GAT-containing regimens with the standard regimen. The aim of this meta-analysis for clinical trials of MOX- or GAT-containing regimens was to evaluate their treatment efficacy and safety in initial therapy for drug-sensitive tuberculosis (TB). Databases were searched for randomized controlled trials, and nine studies with 6980 patients were included. We found that fluoroquinolone substitution for isoniazid or ethambutol in short-course regimens might result in more frequent unfavorable treatment outcomes compared with the standard regimen-in particular, an increased incidence of relapse. In a per-protocol analysis, MOX-containing regimens had slightly higher rates of sputum culture conversion at two months than the standard regimen (RR 1.08, 95% CI 1.04-1.11, P <0.001); there was no significant difference in the rate of sputum conversion between the GAT-containing regimens and the standard regimen (RR 1.13, 95% CI 0.96-1.33, P = 0.13). There were no significant differences in the incidence of death from any cause, including TB, nor were there serious adverse events between the MOX- or GAT-containing regimens and the standard regimen. In conclusion, MOX or GAT might not have the ability to shorten treatment duration in the initial therapy for tuberculosis despite the non-inferiority or even slightly better efficacy in the early phase of treatment compared with the standard regimen. Furthermore, it is safe to include MOX or GAT in initial TB treatment.

Figures

Figure 1
Figure 1
The flow diagram for the study selection
Figure 2
Figure 2
The quality assessment of each included study is summarized in (A) ‘risk of bias summary', or is presented as a percentage across all included studies in (B) ‘risk of bias graph'
Figure 3
Figure 3
Forest plots comparing the rates of sputum conversion at two months for (A) moxifloxacin-containing regimens versus the standard regimen, and (B) gatifloxacin-containing regimens versus the standard regimen. MOX, moxifloxacin; GAT, gatifloxacin
Figure 4
Figure 4
Forest plots comparing the rates of death from any cause and TB-related deaths between MOX-containing regimens and the standard regimen. MOX, moxifloxacin
Figure 5
Figure 5
A forest plot comparing the rates of serious adverse events between MOX-containing regimens and the standard regimen. MOX, moxifloxacin

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