Tuberculosis (TB) remains a global health challenge with 10 million new cases annually. Early interruption of anti-tuberculosis treatment emerges as a determinant for the development of relapses, drug resistance, and increased disease burden. Therapeutic discontinuity is associated with an increased risk of recurrent TB, with important implications for health systems and for patient health. The impact of treatment interruption was systematically evaluated on the following parameters: (1) disease relapse rate, (2) development of resistance to anti-tuberculosis drugs, and (3) treatment abandonment. To this end, observational studies (prospective cohorts and case-control studies) and randomized clinical trials published between 2019 and 2024 were included, evaluating clinical outcomes in patients who interrupted the standard therapeutic regimen for TB. The databases consulted included PubMed, SciELO, Cochrane Library, and Embase, using standardized search strategies. Statistical analysis employed random-effects models, calculation of odds ratio (OR) and relative risk (RR) with 95% confidence intervals, in addition to heterogeneity assessment by the I² test. The results demonstrated an association between treatment discontinuity and occurrence of relapses. Patients with incomplete treatment had an OR of 3.2 for developing recurrent TB when compared to those who completed therapy. Subgroup analysis revealed that relapse rate ranged between 15%–25% in cases of abandonment, versus only 5%–8% in patients who finished treatment as prescribed. An RR of 4.8 was observed for development of multidrug-resistant TB among cases of therapeutic interruption, with 40% of relapse cases showing resistance to at least one first-line drug. Analysis of determinants of abandonment identified 3 main axes: (1) socioeconomic factors; (2) adverse effects of therapy, hepatotoxicity, and gastrointestinal symptoms; and (3) weaknesses in health systems. Therapeutic interruption increases the risk of relapse and favors the emergence of resistant strains, compromising disease control. Psychosocial strategies and interventions were shown to reduce abandonment rates by 30%, highlighting the importance of multifactorial approaches. However, unequal implementation of these measures in low- and middle-income countries remains an obstacle.
Letizia Pires Marchelli (Sun,) studied this question.