Clinical Impact of the Line Probe Assay and Xpert® MTB/RIF Assay in the Presumptive Diagnosis of Drug-Resistant Tuberculosis in Brazil: A Pragmatic Clinical Trial
ABSTRACT Background: Rapid molecular methods such as the line probe assay (LPA) and Xpert® MTB/RIF assay (Xpert) have been recommended by the World Health Organization for drug-resistant tuberculosis (DR-TB) diagnosis. We conducted an interventional trial in DR-TB reference centers in Brazil to eval...
Published in: | Revista da Sociedade Brasileira de Medicina Tropical |
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Sociedade Brasileira de Medicina Tropical (SBMT)
2022
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Online Access: | https://doi.org/10.1590/0037-8682-0191-2021 https://doaj.org/article/ff41475c4ec240eb99101c6e8810c609 |
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ftdoajarticles:oai:doaj.org/article:ff41475c4ec240eb99101c6e8810c609 2023-05-15T15:10:27+02:00 Clinical Impact of the Line Probe Assay and Xpert® MTB/RIF Assay in the Presumptive Diagnosis of Drug-Resistant Tuberculosis in Brazil: A Pragmatic Clinical Trial Afranio Kritski Maria Martha Oliveira Isabela Neves de Almeida Daniela Ramalho Monica Kramer de Noronha Andrade Monica Carvalho Pryscila Fernandes Campino Miranda Margareth Pretti Dalcolmo Jose Ueleres Braga Tania Brígido Eliene Mesquita Claudia Dias Aglae Gambirasio Joao Baptista Souza Filho Anne Detjen Patrick Peter John Phillips Ivor Langley Paula Fujiwara Stephen Bertel Squire 2022-02-01T00:00:00Z https://doi.org/10.1590/0037-8682-0191-2021 https://doaj.org/article/ff41475c4ec240eb99101c6e8810c609 EN eng Sociedade Brasileira de Medicina Tropical (SBMT) http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822022000100301&tlng=en https://doaj.org/toc/1678-9849 1678-9849 doi:10.1590/0037-8682-0191-2021 https://doaj.org/article/ff41475c4ec240eb99101c6e8810c609 Revista da Sociedade Brasileira de Medicina Tropical, Vol 55 (2022) Tuberculosis Diagnostics Impact assessment Molecular tests MDR-TB Arctic medicine. Tropical medicine RC955-962 article 2022 ftdoajarticles https://doi.org/10.1590/0037-8682-0191-2021 2022-12-30T21:26:57Z ABSTRACT Background: Rapid molecular methods such as the line probe assay (LPA) and Xpert® MTB/RIF assay (Xpert) have been recommended by the World Health Organization for drug-resistant tuberculosis (DR-TB) diagnosis. We conducted an interventional trial in DR-TB reference centers in Brazil to evaluate the impact of the use of LPA and Xpert. Methods: Patients with DR-TB were eligible if their drug susceptibility testing results were available to the treating physician at the time of consultation. The standard reference MGITTM 960 was compared with Xpert (arm 1) and LPA (arm 2). Effectiveness was considered as the start of the appropriate TB regimen that matched drug susceptibility testing (DST) and the proportions of culture conversion and favorable treatment outcomes after 6 months. Results: A higher rate of empirical treatment was observed with MGIT alone than with the Xpert assay (97.0% vs. 45.0%) and LPA (98.2% vs. 67.5%). Patients started appropriate TB treatment more quickly than those in the MGIT group (median 15.0 vs. 40.5 days; p<0.01) in arm 1. Compared to the MGIT group, culture conversion after 6 months was higher for Xpert in arm 1 (90.9% vs. 79.3%, p=0.39) and LPA in arm 2 (80.0% vs. 83.0%, p=0.81). Conclusions: In the Xpert arm, there was a significant reduction in days to the start of appropriate anti-TB treatment and a trend towards greater culture conversion in the sixth month. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Rif ENVELOPE(-16.172,-16.172,66.526,66.526) Revista da Sociedade Brasileira de Medicina Tropical 55 |
institution |
Open Polar |
collection |
Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English |
topic |
Tuberculosis Diagnostics Impact assessment Molecular tests MDR-TB Arctic medicine. Tropical medicine RC955-962 |
spellingShingle |
Tuberculosis Diagnostics Impact assessment Molecular tests MDR-TB Arctic medicine. Tropical medicine RC955-962 Afranio Kritski Maria Martha Oliveira Isabela Neves de Almeida Daniela Ramalho Monica Kramer de Noronha Andrade Monica Carvalho Pryscila Fernandes Campino Miranda Margareth Pretti Dalcolmo Jose Ueleres Braga Tania Brígido Eliene Mesquita Claudia Dias Aglae Gambirasio Joao Baptista Souza Filho Anne Detjen Patrick Peter John Phillips Ivor Langley Paula Fujiwara Stephen Bertel Squire Clinical Impact of the Line Probe Assay and Xpert® MTB/RIF Assay in the Presumptive Diagnosis of Drug-Resistant Tuberculosis in Brazil: A Pragmatic Clinical Trial |
topic_facet |
Tuberculosis Diagnostics Impact assessment Molecular tests MDR-TB Arctic medicine. Tropical medicine RC955-962 |
description |
ABSTRACT Background: Rapid molecular methods such as the line probe assay (LPA) and Xpert® MTB/RIF assay (Xpert) have been recommended by the World Health Organization for drug-resistant tuberculosis (DR-TB) diagnosis. We conducted an interventional trial in DR-TB reference centers in Brazil to evaluate the impact of the use of LPA and Xpert. Methods: Patients with DR-TB were eligible if their drug susceptibility testing results were available to the treating physician at the time of consultation. The standard reference MGITTM 960 was compared with Xpert (arm 1) and LPA (arm 2). Effectiveness was considered as the start of the appropriate TB regimen that matched drug susceptibility testing (DST) and the proportions of culture conversion and favorable treatment outcomes after 6 months. Results: A higher rate of empirical treatment was observed with MGIT alone than with the Xpert assay (97.0% vs. 45.0%) and LPA (98.2% vs. 67.5%). Patients started appropriate TB treatment more quickly than those in the MGIT group (median 15.0 vs. 40.5 days; p<0.01) in arm 1. Compared to the MGIT group, culture conversion after 6 months was higher for Xpert in arm 1 (90.9% vs. 79.3%, p=0.39) and LPA in arm 2 (80.0% vs. 83.0%, p=0.81). Conclusions: In the Xpert arm, there was a significant reduction in days to the start of appropriate anti-TB treatment and a trend towards greater culture conversion in the sixth month. |
format |
Article in Journal/Newspaper |
author |
Afranio Kritski Maria Martha Oliveira Isabela Neves de Almeida Daniela Ramalho Monica Kramer de Noronha Andrade Monica Carvalho Pryscila Fernandes Campino Miranda Margareth Pretti Dalcolmo Jose Ueleres Braga Tania Brígido Eliene Mesquita Claudia Dias Aglae Gambirasio Joao Baptista Souza Filho Anne Detjen Patrick Peter John Phillips Ivor Langley Paula Fujiwara Stephen Bertel Squire |
author_facet |
Afranio Kritski Maria Martha Oliveira Isabela Neves de Almeida Daniela Ramalho Monica Kramer de Noronha Andrade Monica Carvalho Pryscila Fernandes Campino Miranda Margareth Pretti Dalcolmo Jose Ueleres Braga Tania Brígido Eliene Mesquita Claudia Dias Aglae Gambirasio Joao Baptista Souza Filho Anne Detjen Patrick Peter John Phillips Ivor Langley Paula Fujiwara Stephen Bertel Squire |
author_sort |
Afranio Kritski |
title |
Clinical Impact of the Line Probe Assay and Xpert® MTB/RIF Assay in the Presumptive Diagnosis of Drug-Resistant Tuberculosis in Brazil: A Pragmatic Clinical Trial |
title_short |
Clinical Impact of the Line Probe Assay and Xpert® MTB/RIF Assay in the Presumptive Diagnosis of Drug-Resistant Tuberculosis in Brazil: A Pragmatic Clinical Trial |
title_full |
Clinical Impact of the Line Probe Assay and Xpert® MTB/RIF Assay in the Presumptive Diagnosis of Drug-Resistant Tuberculosis in Brazil: A Pragmatic Clinical Trial |
title_fullStr |
Clinical Impact of the Line Probe Assay and Xpert® MTB/RIF Assay in the Presumptive Diagnosis of Drug-Resistant Tuberculosis in Brazil: A Pragmatic Clinical Trial |
title_full_unstemmed |
Clinical Impact of the Line Probe Assay and Xpert® MTB/RIF Assay in the Presumptive Diagnosis of Drug-Resistant Tuberculosis in Brazil: A Pragmatic Clinical Trial |
title_sort |
clinical impact of the line probe assay and xpert® mtb/rif assay in the presumptive diagnosis of drug-resistant tuberculosis in brazil: a pragmatic clinical trial |
publisher |
Sociedade Brasileira de Medicina Tropical (SBMT) |
publishDate |
2022 |
url |
https://doi.org/10.1590/0037-8682-0191-2021 https://doaj.org/article/ff41475c4ec240eb99101c6e8810c609 |
long_lat |
ENVELOPE(-16.172,-16.172,66.526,66.526) |
geographic |
Arctic Rif |
geographic_facet |
Arctic Rif |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
Revista da Sociedade Brasileira de Medicina Tropical, Vol 55 (2022) |
op_relation |
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822022000100301&tlng=en https://doaj.org/toc/1678-9849 1678-9849 doi:10.1590/0037-8682-0191-2021 https://doaj.org/article/ff41475c4ec240eb99101c6e8810c609 |
op_doi |
https://doi.org/10.1590/0037-8682-0191-2021 |
container_title |
Revista da Sociedade Brasileira de Medicina Tropical |
container_volume |
55 |
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