Lee SH. Tuberc Respir Dis. 2016 Oct;79(4):201-206. https://doi.org/10.4046/trd.2016.79.4.201

Non-adherence to tuberculosis (TB) treatment is a barrier to effective TB control. We investigated the effectiveness of a Medication Event Monitoring System (MEMS) as a tailored adherence-promoting intervention in Morocco. We compared patients who received a MEMS (n = 206) with patients who received standard TB care (n = 141) among new active TB patients with sputum smear-positive. The mean total medication days were 141.87 ± 29.5 in the control group and 140.85 ± 17.9 in the MEMS group (p = 0.7147), and the mean age and sex were not different between the two groups (p > 0.05). The treatment success rate was significantly higher in the MEMS group than in the control group (odds ratio (OR): 4.33, 95% confidence interval (CI): 2.13–8.81, p < 0.001), and the lost to follow-up rate was significantly lower in the MEMS group than in the control group (OR: 0.03, 95% CI: 0.05–0.24, p < 0.001) after adjusting for sex, age, and health centers. The mean drug adherence rate in the first month was significantly higher in the MEMS group than in the control group (p = 0.023). MEMS increased TB treatment success rate and decreased the lost to follow-up rate overall for infectious TB patients in a Moroccan rural area.

Lee SH. Tuberc Respir Dis. 2015 Apr;78(2):56-63. http://dx.doi.org/10.4046/trd.2015.78.2.56

Treatment success rates of multidrug-resistant tuberculosis (MDR-TB) remain unsatisfactory, and long-term use of second-line anti-TB drugs is accompanied by the frequent occurrence of adverse events, low treatment compliance, and high costs. The development of new efficient regimens with shorter treatment durations for MDR-TB will solve these issues and improve treatment outcomes. This study is a phase II/III, multicenter, randomized, open-label clinical trial of non-inferiority design comparing a new regimen to the World Health Organization-endorsed conventional regimen for fluoroquinolone-sensitive MDR-TB. The control arm uses a conventional treatment regimen with second-line drugs including injectables for 20–24 months. The investigational arm uses a new shorter regimen including delamanid, linezolid, levofloxacin, and pyrazinamide for 9 or 12 months depending on time to sputum culture conversion. The primary outcome is the treatment success rate at 24 months after treatment initiation. Secondary outcomes include time to sputum culture conversion on liquid and solid media, proportions of sputum culture conversion on liquid media after 2 and 6 months of treatment, treatment success rate according to pyrazinamide resistance, and occurrence of adverse events grade 3 and above as evaluated by the Common Terminology Criteria for Adverse Events. Based on an α = 0.025 level of significance (one-sided test), a power of 80%, and a < 10% difference in treatment success rate between the control and investigational arms (80% vs. 70%) when the anticipated actual success rate in the treatment group is assumed to be 90%, the number of participants needed per arm to show non-inferiority of the investigational regimen was calculated as 48. Additionally, assuming the proportion of fluoroquinolone-susceptible MDR-TB among participants as 50%, and 5% loss to follow-up, the number of participants is calculated as N/( 0.50 × 0.95), resulting in 102 persons per group (204 in total). This trial will reveal the effectiveness and safety of a new shorter regimen comprising four oral drugs, including delamanid, linezolid, levofloxacin, and pyrazinamide, for the treatment of fluoroquinolone-sensitive MDR-TB. Results from this trial will provide evidence for adopting a shorter and more convenient treatment regimen for MDR-TB. ClincalTrials.gov, NCT02619994 . Registered on 2 December 2015.

Purpose: No previous investigations of coronavirus disease 2019 (COVID-19) have estimated medical expenses, length of stay, or factors influencing them using administrative datasets. This study aims to fill this research gap for the Republic of Korea, which has over 10,000 confirmed COVID-19 cases. Patients and Methods: Using the nationwide health insurance claims data of 7590 confirmed COVID-19 patients, we estimated average medical expenses and inpatient days per patient, and performed multivariate negative binomial, and gamma regressions to determine influencing factors for higher outcomes. Results: According to the results, COVID-19 patients with history of ICU admission, chest CT imaging, lopinavir/ritonavir and hydroxychloroquine use stayed longer in the hospital and spent more on medical expenses, and anti-hypertensive drugs were insignificantly associated with the outcomes. Female patients stayed longer in the hospital in the over 65 age group but spent less in medical expenses that the 20– 39 group. In the 40– 69 age group, patients with health insurance stayed longer in the hospital and spent more on medical expenses than those aged over 65 years. Comorbidities did not affect outcomes in most age groups. Conclusion: In summary, contrary to popular beliefs, medical expenses and length of hospitalization were mostly influenced by age, and not by comorbidities, anti-viral, or anti-hypertensive drugs. Thus, responses should focus on infection prevention and control rather than clinical countermeasures.