Predictive factors for treatment failure in patients with presumed ocular tuberculosis in an area of low endemic prevalence

2.50
Hdl Handle:
http://hdl.handle.net/11287/594007
Title:
Predictive factors for treatment failure in patients with presumed ocular tuberculosis in an area of low endemic prevalence
Authors:
Agrawal, R.; Gonzalez-Lopez, J. J.; Nobre-Cardoso, J.; Gupta, Bhaskar; Grant, R.; Addison, P. K.; Westcott, M.; Pavesio, C. E.
Abstract:
AIM: To assess the impact of antitubercular therapy (ATT), oral steroids and steroid sparing immunosuppressive treatment on treatment success in cases with presumed ocular tuberculosis in an area of low endemic prevalence. METHODS: A retrospective cross-sectional study was performed for 213 patients with presumed ocular tuberculosis from a database from a tertiary referral eye hospital in the UK. A logistic regression model was constructed incorporating demographics, baseline characteristics and different cut-offs of QuantiFERON-TB Gold In-Tube test (QFT-G) to identify significant factors accounting for the variability of the response variable ('failure') across the whole group. Treatment failure was defined as the recurrence of inflammation or inability to taper steroids within 6 months of completion of ATT or after at least 6 months of treatment in the non-ATT group. RESULTS: There were 126 patients who had at least 6 months of ATT. Patients with QFT-G values >1.50 (OR=0.20, 95% CI 0.09 to 0.48, p<0.001) had less risk of treatment failure as against those with QFT-G values between 0.35 and 1.50. Steroid sparing immunosuppressive agents reduced the chances of treatment success (OR=24.10, 95% CI 6.75 to 86.11, p<0.001). This effect persisted even after adjusting for potential confounding factors. CONCLUSIONS: Patients with higher values of QFT-G (>1.5) are more likely to have treatment success with ATT. In our model, steroid sparing immunosuppressive agents reduced the chances of success in both ATT and non-ATT-treated patients. It is unclear whether this effect reflects the intrinsic underlying severity of disease (ie, study bias), or whether steroid sparing immunosuppressive agents mitigate against successful ATT.
Citation:
Br J Ophthalmol. 2015 Jul 17. [Epub ahead of print]
Publisher:
BMJ
Journal:
The British journal of ophthalmology
Issue Date:
17-Jul-2015
URI:
http://hdl.handle.net/11287/594007
DOI:
10.1136/bjophthalmol-2014-306474
PubMed ID:
26187952
Additional Links:
http://bjo.bmj.com/content/early/2015/07/17/bjophthalmol-2014-306474.long
Note:
RD&E staff can access the full-text of this article by clicking on the 'Additional Link' above and logging in with NHS OpenAthens if prompted.
Type:
Journal Article
Language:
Eng
ISSN:
1468-2079
Appears in Collections:
2015 RD&E publications; Ophthalmology (West of England Eye Unit)

Full metadata record

DC FieldValue Language
dc.contributor.authorAgrawal, R.en
dc.contributor.authorGonzalez-Lopez, J. J.en
dc.contributor.authorNobre-Cardoso, J.en
dc.contributor.authorGupta, Bhaskaren
dc.contributor.authorGrant, R.en
dc.contributor.authorAddison, P. K.en
dc.contributor.authorWestcott, M.en
dc.contributor.authorPavesio, C. E.en
dc.date.accessioned2016-01-19T12:38:31Zen
dc.date.available2016-01-19T12:38:31Zen
dc.date.issued2015-07-17en
dc.identifier.citationBr J Ophthalmol. 2015 Jul 17. [Epub ahead of print]en
dc.identifier.issn1468-2079en
dc.identifier.pmid26187952en
dc.identifier.doi10.1136/bjophthalmol-2014-306474en
dc.identifier.urihttp://hdl.handle.net/11287/594007en
dc.description.abstractAIM: To assess the impact of antitubercular therapy (ATT), oral steroids and steroid sparing immunosuppressive treatment on treatment success in cases with presumed ocular tuberculosis in an area of low endemic prevalence. METHODS: A retrospective cross-sectional study was performed for 213 patients with presumed ocular tuberculosis from a database from a tertiary referral eye hospital in the UK. A logistic regression model was constructed incorporating demographics, baseline characteristics and different cut-offs of QuantiFERON-TB Gold In-Tube test (QFT-G) to identify significant factors accounting for the variability of the response variable ('failure') across the whole group. Treatment failure was defined as the recurrence of inflammation or inability to taper steroids within 6 months of completion of ATT or after at least 6 months of treatment in the non-ATT group. RESULTS: There were 126 patients who had at least 6 months of ATT. Patients with QFT-G values >1.50 (OR=0.20, 95% CI 0.09 to 0.48, p<0.001) had less risk of treatment failure as against those with QFT-G values between 0.35 and 1.50. Steroid sparing immunosuppressive agents reduced the chances of treatment success (OR=24.10, 95% CI 6.75 to 86.11, p<0.001). This effect persisted even after adjusting for potential confounding factors. CONCLUSIONS: Patients with higher values of QFT-G (>1.5) are more likely to have treatment success with ATT. In our model, steroid sparing immunosuppressive agents reduced the chances of success in both ATT and non-ATT-treated patients. It is unclear whether this effect reflects the intrinsic underlying severity of disease (ie, study bias), or whether steroid sparing immunosuppressive agents mitigate against successful ATT.en
dc.language.isoEngen
dc.publisherBMJen
dc.relation.urlhttp://bjo.bmj.com/content/early/2015/07/17/bjophthalmol-2014-306474.longen
dc.titlePredictive factors for treatment failure in patients with presumed ocular tuberculosis in an area of low endemic prevalenceen
dc.typeJournal Articleen
dc.identifier.journalThe British journal of ophthalmologyen
dc.description.noteRD&E staff can access the full-text of this article by clicking on the 'Additional Link' above and logging in with NHS OpenAthens if prompted.en

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