Background In 2019, the South African tuberculosis program replaced ethionamide with linezolid as a part of an all-oral 9-month regimen. We evaluated treatment outcomes for patients assigned to regimens including linezolid in 2019 and ethionamide in 2017. Method This retrospective cohort study included patients treated for multi-drug resistant/rifampicin-resistant tuberculosis throughout South Africa between 1 Jan to 31 Dec 2017 and from 1 Jan to 31 Dec 2019. The cohort treated with a 9-month regimen containing ethionamide for four months, was compared with a cohort treated with a 9-month regimen containing linezolid for two months. The regimens were otherwise identical. Inverse probability weighting of propensity scores was used to adjust for potential confounding. A log-binomial regression model was used to estimate adjusted relative risk (aRR) comparing 24-month outcomes between cohorts including treatment success, death, loss to follow up, and treatment failure. Adverse event data were available for the linezolid cohort. Findings 817 patients were included in the cohort receiving ethionamide and 4244 in the cohort receiving linezolid. No evidence for a difference was observed between linezolid and ethionamide regimens for treatment success (aRR = 0·96, 95%CI 0·91-1·01), death (aRR = 1·01, 95%CI 0·87-1·17) or treatment failure (aRR = 0·87, 95%CI 0·44-1·75). Loss to follow up was more common in the linezolid group, although estimates were imprecise (aRR = 1·22, 95%CI 0·99-1·50). Interpretation No significant differences in treatment success and survival were observed with substitution of linezolid for ethionamide as a part of an all-oral 9-month regimen. Linezolid is an acceptable alternative to ethionamide in this shorter regimen for treatment of multi-drug resistant/rifampicin resistant tuberculosis.

中文翻译：

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南非采用含有利奈唑胺或乙硫异烟胺的全口服 9 个月方案治疗耐多药或利福平结核病：一项回顾性队列研究

背景 2019 年，南非结核病防治项目用利奈唑胺取代了乙硫异烟胺，作为 9 个月全口服治疗方案的一部分。我们评估了2019年分配到利奈唑胺和2017年乙硫异烟胺等治疗方案的患者的治疗结果。方法这项回顾性队列研究包括2017年1月1日至12月31日以及1月1日起在南非各地接受耐多药/利福平耐药结核病治疗的患者至 2019 年 12 月 31 日。将接受包含乙硫异烟胺的 9 个月方案治疗 4 个月的队列与接受包含利奈唑胺的 9 个月方案治疗 2 个月的队列进行比较。治疗方案在其他方面是相同的。倾向得分的逆概率加权用于调整潜在的混杂因素。使用对数二项式回归模型来估计调整后的相对风险 (aRR)，比较队列之间 24 个月的结果，包括治疗成功、死亡、失访和治疗失败。利奈唑胺队列的不良事件数据可用。研究结果显示，接受乙硫异烟胺的队列中包括 817 名患者，接受利奈唑胺的队列中包括 4244 名患者。没有证据表明利奈唑胺和乙硫异烟胺治疗方案在治疗成功率 (aRR = 0·96, 95%CI 0·91-1·01) 和死亡 (aRR = 1·01, 95%CI 0·87-1) 方面存在差异·17) 或治疗失败 (aRR = 0·87, 95%CI 0·44-1·75)。尽管估计值不精确，但利奈唑胺组失访更为常见（aRR = 1·22，95%CI 0·99-1·50）。解释 在 9 个月全口服方案中，用利奈唑胺替代乙硫异烟胺，治疗成功率和生存率没有显着差异。在这种较短的治疗耐多药/利福平耐药结核病的方案中，利奈唑胺是乙硫异烟胺的可接受替代品。