tibljТуберкулез и болезни легкихTuberculosis and Lung Diseases2075-12302542-1506Медицинские знания и технологии10.58838/2075-1230-2025-103-4-8-23tiblj-1901Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHЭффективность и безопасность коротких режимов химиотерапии лекарственно-чувствительного туберкулеза легких: систематический обзор и метаанализEffectiveness and Safety of Short-Course Chemotherapy for Drug-Susceptible Pulmonary Tuberculosis: a Systematic Review and Meta-Analysishttps://orcid.org/0000-0002-3912-679XГусеваВ. А.GusevaV. A.

Гусева Валерия Александровна, руководитель центра телемедицины

127473, Москва, ул. Достоевского, д. 4, к. 2 Тел.: +7 (495) 631-15-15

Valeriya A. Guseva, Head of Telemedicine Center

2, 4 Dostoevskiy St., Moscow, 127473 Phone: +7 (495) 631-15-15

gusevava@nmrc.ruhttps://orcid.org/0000-0002-0637-7955ВасильеваИ. А.VasilyevaI. A.

Васильева Ирина Анатольевна, д. м. н, профессор, директор, заведующая кафедрой фтизиатрии ИКМ ФГАОУ ВО «РНИМУ им. Н. И. Пирогова» МЗ РФ

127473, Москва, ул. Достоевского, д. 4, к. 2 Тел.: +7 (495) 631-15-15

Irina A. Vasilyeva, Doctor of Medical Sciences, Professor, Director, Head of Phthisiology Department, Clinical Medicine Institute, Pirogov Russian National Research Medical University, Russian Ministry of Health

2, 4 Dostoevskiy St., Moscow, 127473 Phone: +7 (495) 631-15-15

nmrc@nmrc.ruТестовВ. В.TestovV. V.

Тестов Вадим Витальевич, к. м. н., заместитель директора по организационно-методической работе

127473, Москва, ул. Достоевского, д. 4, к. 2 Тел.: +7 (495) 631-15-15

Vadim V. Testov, Candidate of Medical Sciences, Deputy Director for Statistics and Reporting

2, 4 Dostoevskiy St., Moscow, 127473 Phone: +7 (495) 631-15-15

testov.vadim@mail.ruФГБУ «Национальный медицинский исследовательский центр фтизиопульмонологии и инфекционных заболеваний» МЗ РФРоссияNational Medical Research Center of Phthisiopulmonology and Infectious Diseases, Russian Ministry of HealthRussian FederationФГБУ «Национальный медицинский исследовательский центр фтизиопульмонологии и инфекционных заболеваний» МЗ РФ; ФГАОУ ВО «Российский национальный исследовательский медицинский университет им Н.И. Пирогова» МЗ РФРоссияNational Medical Research Center of Phthisiopulmonology and Infectious Diseases, Russian Ministry of Health; Pirogov Russian National Research Medical University, Russian Ministry of HealthRussian Federation2025120920251034823Copyright © Гусева В.А., Васильева И.А., Тестов В.В., 20252025Гусева В.А., Васильева И.А., Тестов В.В.Guseva V.A., Vasilyeva I.A., Testov V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.tibl-journal.com/jour/article/view/1901

Цель исследования: сравнительный анализ по публикациям эффективности и безопасности лечения туберкулеза органов дыхания с подтвержденной лекарственной чувствительностью M. tuberculosis при коротких схемах и шестимесячном режиме терапии.Материалы и методы. С 01 января 2010 г. по 21 января 2025 г. в базах данных был проведен систематический поиск рандомизированных и квази-рандомизированных контролируемых клинических исследований по ключевым словам «туберкулез легких», «чувствительность к лекарственным средствам» и «короткие схемы лечения». Восемь исследований соответствовали критериям отбора и были включены в последующий систематический обзор и метаанализ. Первичные результаты были сосредоточены на риске рецидива туберкулеза и неэффективности лечения, а также на развитии серьезных нежелательных явлений при использовании коротких режимов химиотерапии. Вторичные результаты включали конверсию мокроты к 8-й неделе лечения, появление приобретенной лекарственной устойчивости и летальный исход во время курса лечения короткими схемами.Результаты. Метаанализ показал, что при использовании коротких режимов лечения риск развития рецидива в три раза выше, чем при лечении шестимесячным режимом химиотерапии лекарственно-чувствительного туберкулеза (RR 2,97, 95% ДИ (2,29-3,85)). Короткие схемы терапии незначительно повышают риск неэффективности лечения (RR 1,47, 95% ДИ (1,27-1,71)) и не оказывают значительного влияния на летальный исход во время лечения (RR 0,57, 95% ДИ (0,33-0,99)), частоту серьезных нежелательных явлений (RR 0,90, 95% ДИ (0,81-1,01)) или конверсию мокроты к 8 неделе лечения (RR 1,12, 95% ДИ (1,08-1,16)). На основании результатов метаанализа невозможно сделать однозначный вывод о том, может ли применение коротких режимов лечения привести к развитию лекарственной устойчивости (RR 0,45, 95% ДИ (0,12-1,73)).

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)).

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The authors declare that there are no conflicts of interest present.