Outcomes of clofazimine for the treatment of drug-resistant tuberculosis: a systematic review and meta-analysis

Authors: Teesta Dey, Grania Brigden, Helen Cox, Zara Shubber, Graham Cooke and Nathan Ford

Background:

Current anti-tuberculosis therapeutics are not sufficiently effective against drug-resistant tuberculosis (DR-TB), and there is a need for new drugs and therapeutic approaches. It has been proposed that repurposing clofazimine for DR-TB treatment might be one way to increase therapeutic options.

Methods:

We conducted a systematic review of studies reporting on the efficacy and safety of clofazimine as part of combination therapy for DR-TB. Six databases and six conference abstract sites were searched from inception until April 2012. All studies involving the use of clofazimine in the treatment of DR-TB were included.

Results:

Twelve studies, comprising 3489 patients across 10 countries, were included in this review. Treatment success ranged from 16.5% (95% CI 2.7%–38.7%) to 87.8% (95% CI 76.8%–95.6%), with an overall pooled proportion of 61.96% achieving treatment success (95% CI 52.79%–71.12%) (t2 0.07). Mortality, treatment interruptions, defaulting and adverse events were all in line with DR-TB treatment outcomes overall. The most commonly reported adverse events were gastrointestinal disturbances and skin pigmentation.

Conclusions:

The available evidence to date suggests that clofazimine could be considered as an additional therapeutic option in the treatment of DR-TB. The optimal dose of clofazimine and duration of use require further investigation.