NEW findings from a European cohort study reveal dismal treatment success rates for extensively drug-resistant tuberculosis (XDR-TB), underscoring urgent gaps in regimen design and access to effective therapies.
This observational, retrospective cohort study assessed outcomes for patients with XDR-TB in the WHO European Region between 2017 and 2023. Conducted across 16 countries, the study analysed detailed individual data from 188 XDR-TB cases identified among 11,003 multidrug- or rifampicin-resistant TB patients (1.7%). XDR-TB was defined according to the WHO’s revised 2021 classification. Researchers applied meta-analytical and regression methods to evaluate treatment outcomes and predictors, while adjusting for between-country variability and disease severity.
Of the 188 XDR-TB patients, resistance to key drugs was alarmingly common: 48.4% were resistant to bedaquiline, 34.0% to linezolid, and 17.6% to both. Treatment regimens varied widely, with 151 distinct drug combinations reported. Among the 156 patients with known outcomes, only 40.2% (95% CI 28.4–53.2%) achieved successful treatment. Treatment failure occurred in 37.1% (95% CI 26.1–49.7%) and death in 21.3% (95% CI 15.7–28.2%). Importantly, each additional likely effective drug in a regimen reduced the odds of treatment failure or death (adjusted odds ratio [OR] 0.65, 95% CI 0.45–0.96; p=0.026). Conversely, being treated in an upper-middle-income country significantly increased the odds of unsuccessful outcomes (adjusted OR 13.7, 95% CI 3.7–50.2; p<0.001). Compared with other forms of drug-resistant TB, outcomes for XDR-TB were significantly poorer.
These findings highlight the pressing need for individualised treatment plans supported by rapid, reliable drug susceptibility testing, and equitable access to effective anti-TB drugs across all countries in the region.
Reference
Kherabi Y et al. Treatment outcomes of extensively drug-resistant tuberculosis in Europe: a retrospective cohort study. Lancet Reg Health Eur. 2025; DOI:10.1016/j.lanepe.2025.101380.
