Peer-reviewedCC BYNature communications
Risk stratification for MDR/RR-TB: a comprehensive integrated patient-level analysis from TB programs and contemporary clinical trials.
12 affiliations
- 1Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA.
- 2Department of Pharmaceutics and Food Technology, School of Pharmacy, Complutense University of Madrid, Madrid, Spain.
- 3Institute of Industrial Pharmacy, Complutense University of Madrid, Madrid, Spain.
- 4Department of Global and Public Health, McGill University, Montreal, QC, Canada.
- 5Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
- 6Center for Tuberculosis, UCSF Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA.
- 7Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA.
- 8Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA.
- 9Department of Medicine, McGill University, Montreal, QC, Canada.
- 10Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA. [email protected].
- 11Center for Tuberculosis, UCSF Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA. [email protected].
- 12Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA. [email protected].
Abstract
Tuberculosis is the deadliest infectious disease, and treatments for multidrug-resistant tuberculosis are lengthy and toxic. By analyzing a large international database (N = 7,750), we identified patient risk phenotypes linked to unfavorable outcomes. Factors like HIV infection, age, low BMI, smoking, acid-fast bacillus smear positivity, extrapulmonary involvement, and cavitary disease were associated (p < 0.001) with worse clinical outcomes (ROC AUC 0.728; 95% CI 0.726-0.731) and were used to derive a patient risk score. Low-risk patients had a lower probability of unfavorable outcome over time since treatment initiation compared to high-risk patients (p < 0.001). External validation with a highly effective 6-month BPaL regimen showed 97% treatment success for low-risk patients and 88% for medium-to-high-risk patients. Stratifying patients by risk phenotype enables more effective, personalized tuberculosis interventions, which are key to improving cure rates.
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BibTeX
@article{garciacremades2026risk,
title = {{Risk stratification for MDR/RR-TB: a comprehensive integrated patient-level analysis from TB programs and contemporary clinical trials.}},
author = {Maria Garcia-Cremades and Jonathon R Campbell and Natasha Strydom and Belén P Solans and Samer Mouksassi and Ziran Li and Patrick P J Phillips and Gustavo E Velásquez and Payam Nahid and Dick Menzies and Radojka M Savic},
journal = {Nature communications},
year = {2026},
month = sep,
doi = {10.1038/s41467-026-77931-0},
url = {https://europepmc.org/article/MED/42971965},
note = {CC BY},
}
RIS
TY - JOUR
TI - Risk stratification for MDR/RR-TB: a comprehensive integrated patient-level analysis from TB programs and contemporary clinical trials.
AU - Maria Garcia-Cremades
AU - Jonathon R Campbell
AU - Natasha Strydom
AU - Belén P Solans
AU - Samer Mouksassi
AU - Ziran Li
AU - Patrick P J Phillips
AU - Gustavo E Velásquez
AU - Payam Nahid
AU - Dick Menzies
AU - Radojka M Savic
PY - 2026
DA - 2026/09/22
JO - Nature communications
DO - 10.1038/s41467-026-77931-0
UR - https://europepmc.org/article/MED/42971965
AB - Tuberculosis is the deadliest infectious disease, and treatments for multidrug-resistant tuberculosis are lengthy and toxic. By analyzing a large international database (N = 7,750), we identified patient risk phenotypes linked to unfavorable outcomes. Factors like HIV infection, age, low BMI, smoking, acid-fast bacillus smear positivity, extrapulmonary involvement, and cavitary disease were associated (p < 0.001) with worse clinical outcomes (ROC AUC 0.728; 95% CI 0.726-0.731) and were used to derive a patient risk score. Low-risk patients had a lower probability of unfavorable outcome over time since treatment initiation compared to high-risk patients (p < 0.001). External validation with a highly effective 6-month BPaL regimen showed 97% treatment success for low-risk patients and 88% for medium-to-high-risk patients. Stratifying patients by risk phenotype enables more effective, personalized tuberculosis interventions, which are key to improving cure rates.
SN - 2041-1723
ER -