Download This Paper
Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.
The Association of SARS-CoV-2 Infection and Tuberculosis Disease with Unfavorable Treatment Outcomes: A Systematic Review
21 Pages Posted: 7 Dec 2022
More...Abstract
Background: Whether SARS-CoV-2 infection and its management influence tuberculosis (TB) treatment outcomes is uncertain. We conducted a systematic review to synthesize evidence on whether persons treated for TB have worse TB outcomes when infected with SARS-CoV-2 (Coinfection Review), and whether corticosteroids or other immunomodulating COVID-19 treatments improve TB and/or COVID-19 outcomes for persons with SARS-CoV-2 infection and TB (Clinical Management Review).
Methods: We searched MEDLINE, Embase, Web of Science, Scopus, medRxiv, bioRxiv, and WHO library from 1 January 2020 to 6 February 2022. We included cohort, case-control, or randomized trials with relevant data for our primary or secondary outcomes of interest. Primary outcomes included: unfavorable (death, treatment failure, loss-to-follow-up) TB treatment outcomes (Coinfection and Clinical Management Review) and/or severe or critical COVID-19 or death (Clinical Management Review). Study quality was assessed with an adapted Newcastle Ottawa Scale. Data were heterogeneous and a narrative review was performed.
Findings: From 9,529 records, we included 11 studies and 7305 unique participants. Evidence from all studies was judged to be low quality and no study was primarily designed to answer our research questions of interest. Eight studies of 5749 persons treated for TB were included in the Coinfection Review. Overall, 286 (5%) had SARS-CoV-2 infection and TB. Across five studies reporting our primary outcome, there was no significant association between SARS-CoV-2 coinfection and unfavorable TB treatment outcomes. Four studies of 1572 TB patients—of whom 291 (19%) received corticosteroids or other immunomodulating treatment—were included in the Clinical Management Review, and two addressed a primary outcome. One study reported crude odds of unfavorable TB treatment outcomes were significantly higher among those receiving corticosteroids or other immunomodulating treatment, however this finding was likely confounded by indication. One study reported that steroid use was not associated with severe/critical COVID-19 or death after adjustment for demographic and clinical variables and indication for steroid use.
Interpretation: No study was designed to answer our research questions of interest. It remains unclear whether TB/SARS-CoV-2 and its therapeutic management are associated with unfavorable outcomes. Research is needed to improve our understanding of risk and optimal management of persons with TB and SARS-CoV-2 infection.
Funding Information: This study was funded by World Health Organization.
Declaration of Interests: NKV reports receiving consulting fees from Broadstreet HEOR for unrelated projects. JRC reports receiving consulting fees from the COVID-19 Immunity Task Force (Canada) and The World Bank, for unrelated projects. The other authors do not have competing interests.
Keywords: tuberculosis, SARS-CoV-2, outcomes, infectious diseases, evidence synthesis
Suggested Citation: Suggested Citation