Temporal trends of pharmacologic treatments for tuberculosis and multidrug-resistant tuberculosis following treatment guideline dissemination in South Korea

초록

Background: The first treatment guideline for multidrug-resistant (MDR) tuberculosis (TB) was released by the World Health Organization in 2008, followed by updates in 2011; Korea disseminated corresponding guidelines in 2011 and 2014, respectively. Despite the appropriate choice of treatment regimen being a key factor in successfully treating both TB and MDR-TB, there is limited evidence on the concordance between real-world prescription patterns of anti-TB drugs and those recommended by guidelines. Objectives: To describe temporal patterns of TB pharmacologic treatments and to investigate the impact of MDR-TB treatment guidelines disseminated by the Korea Centers for Disease Control and Prevention on real-world prescribing practice. Methods: We conducted a descriptive time-series study using South Korea's nationwide healthcare database from Jan 2007 to Dec 2015. We identified patients with TB or MDR-TB by using domestic relieved co-payment policy codes, which are more accurate than diagnosis codes owing to the close management these patients provided by the government. Anti-TB drugs prescribed during the intensive treatment phase for TB (2-month) or MDR-TB (8-month) were eligible for drug utilization assessment. We estimated the annual utilization of TB treatment regimen of first-line oral anti-TB drugs among TB patients. As for MDR-TB patients, we calculated the relative difference (RD) in the proportion of each pharmacologic treatments for MDR-TB in-between the following three periods: before the first Korean guideline (Jun 2008 to Mar 2011); between the first and revised guidelines (Apr 2011 to Jul 2014); after the revised guideline (Aug 2014 to Dec 2015). Results: Of 3,523 patients with TB (mean age 54.1 years; male 56.8%), treatment regimens complied well with both domestic and WHO's guideline recommendations as >80% of patients received either quadruple (mean 66.8%) or triple (14.5%) therapy involving first-line oral anti-TB drugs. Following the WHO's guideline update on MDR-TB, prescription patterns changed accordingly among 111 patients with MDR-TB (mean age 46.0 years; male 67.6%), as use of pyrazinamide (RD +20.3%) and prothionamide (+11.5%) increased (recommended to be compulsory), and streptomycin (-43.1%) decreased (ototoxicity risks). Conclusions: Findings from this nationwide study showed that patterns of anti-TB drugs prescribed for TB and MDR-TB reflected both the WHO's and domestic treatment guidelines, suggesting that healthcare providers were aware with recent guideline recommendations and followed them well.