Six Months versus 9 Months of Anti-TB Therapy for Abdominal Tuberculosis: A Meta-Analysis
DC Esguerra, M.D., KR Subedi, M.D., LE Abola, M.D. Section of Gastroenterology, Department of Internal Medicine
University of the East Ramon Magsaysay Memorial Medical Center Inc., Quezon City, Philippines.
Significance: Abdominal tuberculosis, which is one of the most prevalent forms of extrapulmonary tuberculosis, is an increasing health problem mainly due to the increasing incidence of AIDS and multi-drug resistant tuberculosis. In the Philippines, tuberculosis (TB) is the sixth leading cause of morbidity and mortality. A 6-month treatment regimen has been recommended for abdominal tuberculosis based on the 2016 clinical practice guidelines for the diagnosis, prevention and treatment of tuberculosis for adult Filipinos. Many clinicians still extend the treatment to 9 or 12 months. We sought to find out whether 6 months therapy is as effective as 9 months therapy.
Methodology: A comprehensive electronic literature search was carried out for RCTs comparing six versus 9 months therapy for abdominal tuberculosis. Internet database search was done in Cochrane, PubMed, and Google Scholar. Validation was done using the JADAD score. The Cochrane risk of bias tool was used to assess methodological quality. Statistical analysis was done using the software RevMan v5.3. Fixed model Mantel-Haenszel meta-analysis was used.
Results: Two out of four retrieved trials were included. Fixed model meta-analysis showed that there was no statistically significant difference between six months treatment versus nine months treatment for abdominal tuberculosis as overall Mean difference was 0.95, 95% CI: 0.53 – 1.71, p-value =0.88. There was no heterogeneity noted.
Conclusion: A six-month treatment for abdominal tuberculosis is as effective as nine months of treatment in terms of achieving complete response to treatment.
Keywords: Meta-analysis, abdominal tuberculosis, treatment duration, six months versus 9 months