Effectiveness and Safety of Short-Course Chemotherapy for Drug-Susceptible Pulmonary Tuberculosis: a Systematic Review and Meta-Analysis

The objective: A comparative analysis of effectiveness and safety of treatment for respiratory tuberculosis with confirmed drug susceptibility of M. tuberculosis using short-course regimens and a six-month regimen, based on the published data. Subjects and Methods. A systematic search for randomized and quasi-randomized controlled clinical trials was conducted in databases from January 1, 2010 to January 21, 2025 using the keywords "pulmonary tuberculosis", "drug susceptibility" and "short-course regimens". Eight trials met the selection criteria and were included in the subsequent systematic review and meta-analysis. The primary outcomes focused on the risk of tuberculosis relapse and treatment failure, as well as development of serious adverse events during treatment with short-course regimens. Secondary outcomes included sputum conversion by week 8 of treatment, emergence of acquired drug resistance, and death during treatment with short-course regimens. Results. According to the meta-analysis results, the risk of relapse was three times higher with short-course regimens versus a six-month regimen for drug-susceptible tuberculosis (RR 2.97, 95% CI (2.29-3.85). Short-course regimens slightly increase the risk of treatment failure (RR 1.47, 95% CI (1.27-1.71)) and provide no significant impact on death during treatment (RR 0.57, 95% CI (0.33-0.99)), incidence of serious adverse events (RR 0.90, 95% CI (0.81-1.01)), and sputum conversion by week 8 of treatment (RR 1.12, 95% CI (1.08-1.16)). Based on the meta-analysis results, it is impossible to draw a clear conclusion whether short-course regimens can lead to development of drug resistance (RR 0.45, 95% CI (0.12-1.73)).