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Forgiveness is the attribute of the strong : nonadherence and regimen-shortening in drug-sensitive TB
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dc.contributor.author | Stagg, Helen R | |
dc.contributor.author | Thompson, Jennifer A | |
dc.contributor.author | Lipman, Marc C I | |
dc.contributor.author | Sloan, Derek J | |
dc.contributor.author | Flook, Mary | |
dc.contributor.author | Fielding, Katherine L | |
dc.date.accessioned | 2024-01-15T00:35:22Z | |
dc.date.available | 2024-01-15T00:35:22Z | |
dc.date.issued | 2023-01-15 | |
dc.identifier | 280978878 | |
dc.identifier | 82132373-5a59-44c1-9713-8e9c437bea73 | |
dc.identifier | 000912325900015 | |
dc.identifier | 85146364763 | |
dc.identifier.citation | Stagg , H R , Thompson , J A , Lipman , M C I , Sloan , D J , Flook , M & Fielding , K L 2023 , ' Forgiveness is the attribute of the strong : nonadherence and regimen-shortening in drug-sensitive TB ' , American Journal of Respiratory and Critical Care Medicine , vol. 207 , no. 2 , pp. 193-205 . https://doi.org/10.1164/rccm.202201-0144oc | en |
dc.identifier.issn | 1073-449X | |
dc.identifier.other | Jisc: 544377 | |
dc.identifier.other | ORCID: /0000-0002-7888-5449/work/129147929 | |
dc.identifier.uri | https://hdl.handle.net/10023/29008 | |
dc.description | Funding: HRS and MF are supported by the UK Medical Research Council (MRC) [MR/R008345/1]. HRS and MCIL are supported through the National Institute for Health Research (NIHR) Health Technology Assessment Programme, UK [16/88/06]. JAT is jointly funded by the UK MRC and the UK Foreign, Commonwealth and Development Office (FCDO) under the MRC/FCDO Concordat agreement and is also part of the EDCTP2 programme supported by the European Union. Grant Ref: MR/R010161/1. KLF is partly funded by the UK MRC and the UK FCDO under the MRC/FCDO Concordat agreement and is also part of the EDCTP2 programme supported by the European Union. | en |
dc.description.abstract | Rationale : ‘Forgiveness’ charts the ability of a drug or regimen to withstand non-adherence without negative clinical consequences. Objectives : We aimed to determine the influence of regimen length, regimen drugs and dosing, and when during treatment non-adherence occurs on the forgiveness of anti-tuberculosis regimens. Methods : Using data from three randomised controlled trials comparing experimental four-month regimens for drug-sensitive tuberculosis with the standard six-month regimen, we used generalised linear models to examine how the risk of a negative composite outcome changed as dose-taking decreased. The percentage of doses taken and absolute number of doses missed were calculated, during the intensive and continuation phases of treatment, and overall. A mediation analysis was undertaken to determine how much of the association between intensive phase dose-taking and the negative composite outcome was mediated through continuation phase dose-taking. Measurements and Main Results : Forgiveness of the four-month and six-month regimens did not differ for any treatment period. Importantly, four-month regimens were no less forgiving of small numbers of absolute missed doses than the six-month regimen (e.g. for 3-7 missed doses versus no missed doses (baseline), six-month regimen adjusted risk ratio 1.65 (95% confidence interval 0.80-3.41) and four-month regimens 1.80 (1.33-2.45)). No four-month regimen was conclusively more forgiving than another. We found evidence of mediation by continuation phase dose-taking on the intensive phase dose-taking and negative composite outcome relationship. Conclusions : With the current appetite for, and progress towards, shorter drug-sensitive tuberculosis regimens worldwide, we offer reassurance that shorter regimens are not necessarily less forgiving of non-adherence. Given the importance of continuation phase adherence, patient support during this period should not be neglected. | |
dc.format.extent | 13 | |
dc.format.extent | 2921277 | |
dc.language.iso | eng | |
dc.relation.ispartof | American Journal of Respiratory and Critical Care Medicine | en |
dc.subject | Tuberculosis | en |
dc.subject | Forgiveness | en |
dc.subject | Adherence | en |
dc.subject | Non-adherence | en |
dc.subject | Treatment | en |
dc.subject | RM Therapeutics. Pharmacology | en |
dc.subject | 3rd-DAS | en |
dc.subject | SDG 3 - Good Health and Well-being | en |
dc.subject | AC | en |
dc.subject | MCC | en |
dc.subject.lcc | RM | en |
dc.title | Forgiveness is the attribute of the strong : nonadherence and regimen-shortening in drug-sensitive TB | en |
dc.type | Journal article | en |
dc.contributor.institution | University of St Andrews. School of Medicine | en |
dc.contributor.institution | University of St Andrews. Infection and Global Health Division | en |
dc.identifier.doi | 10.1164/rccm.202201-0144oc | |
dc.description.status | Peer reviewed | en |
dc.date.embargoedUntil | 2024-01-15 |
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