Targeted next-generation sequencing to diagnose drug-resistant tuberculosis: a systematic review and meta-analysis
Meta-analysis (24 test accuracy studies;23 TB drugs/drug groups) found targeted next-generation sequencing highly sensitive (94·1% [95% CrI 90.9–96.3]) & specific (98·1%[97.0–98.9]) for detecting drug resistance across panels of TB drugs & can be done directly on clinical samples
Source:
The Lancet Infectious Diseases
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SPS commentary:
According to a commentary, the results of the meta-analysis are exciting, but also sobering for several reasons. First, although samples came from 53 countries, sequencing was mainly done in USA, Western Europe, India, and China. Second, the results are mostly limited to drugs for which simpler tests already exist and the study was unable to determine pooled estimates for the accuracy of targeted next-generation sequencing (NGS) for the complete BPaLM regimen, the regimen of choice for treatment of rifampicin-resistant tuberculosis, due to limited data. Third, no accuracy data were provided for clofazimine, and gene targets for cycloserine, terizidone, aminosalicylic acid, imipenem, and meropenem were not included in any of the targeted NGS assays. It notes therefore that targeted NGS does not provide comprehensive guidance for the development of rescue regimens in cases in which resistance is detected to bedaquiline, linezolid, or pretomanid. It concludes for this reason that the results of this systematic review and meta-analysis are unlikely to increase the sense of urgency to implement targeted NGS or sway policy makers into investing in the roll out of NGS technologies.