Title:Mycobacterium w Immunotherapy for Treating Pulmonary Tuberculosis - a Systematic Review
VOLUME: 20 ISSUE: 39
Author(s):Shaheen Pandie, Mark E. Engel, Zita S. Kerbelker and Bongani M. Mayosi
Affiliation:Department of Medicine, Old Groote Schuur Hospital, Observatory 7925, Cape Town, South Africa.
Keywords:Tuberculosis, Mycobacterium w, immunotherapy.
Abstract:Background: Tuberculosis (TB) remains a global health catastrophe. Mycobacterium w is a heat-killed immune-modulating
vaccine designed to attenuate the effects of TB, reduce time to sputum conversion, and thereby decrease transmission and improve cure
rates.
Objectives: To evaluate Mycobacterium w (M w) immunotherapy as an adjunct to chemotherapy in participants with pulmonary TB
(PTB).
Search strategy: In January 2012, we performed both a database search, a handsearch and corresponded with experts in the field.
Selection criteria: Randomised and quasi-randomised controlled trials of M w immunotherapy versus placebo (or no control) for participants
with PTB.
Data collection and analysis: Two of the authors (SP and ZK) independently extracted data. Dichotomous outcomes were analysed using
risk ratios (RR) and 95% confidence intervals (CI).
Outcomes: The primary outcome was to determine the effect of M w therapy on sputum conversion. Secondary outcomes were to determine
the frequency of adverse reactions.
Main Results: Three trials (four papers) involving 368 participants were included. All four papers had methodological flaws. Overall,
173 participants received M w and 168 participants received placebo or no control. M w immunotherapy was effective at reducing time to
sputum conversion at days 15 (RR 2.31; 95% CI 1.75 to 3.06; P < 0.001) and 30 (RR 1.83; 95% CI 1.12 to 2.98; P = 0.02). After day 30,
benefit was only demonstrated in the category II TB (re-treatment).
Conclusions: The meta-analysis suggests benefit as regards the time to sputum conversion. The available data on M w immunotherapy
for participants with PTB are however methodologically flawed. We advise that M w be investigated in a well-structured, randomised
controlled trial.
