Article Text

PDF
Predictive factors for treatment failure in patients with presumed ocular tuberculosis in an area of low endemic prevalence
  1. Rupesh Agrawal1,2,3,
  2. Julio J Gonzalez-Lopez1,
  3. João Nobre-Cardoso1,
  4. Bhaskar Gupta4,
  5. Robert Grant5,
  6. Peter KF Addison1,
  7. Mark Westcott1,
  8. Carlos E Pavesio1,2
  1. 1Department of Medical Retina, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
  2. 2Biomedical Research Centre, UCL Institute of Ophthalmology, London, UK
  3. 3Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
  4. 4Department of Medical Retina, Royal Devon and Exeter NHS Trust, Exeter, UK
  5. 5St George's, University of London & Kingston University, Kingston, UK
  1. Correspondence to Dr Carlos E Pavesio, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK; carlos.pavesio{at}moorfields.nhs.uk

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.

  • Infection
  • Inflammation

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • At a glance
    Keith Barton James Chodosh Jost Jonas