Impact of bedaquiline on treatment outcomes of multidrug-resistant tuberculosis in a high-burden country.

Abstract

BACKGROUND:

Evaluation of novel anti-tuberculosis (TB) drugs for the treatment of multidrug-resistant (MDR)-TB continues to be of high interest on the TB research agenda. We assessed treatment outcomes in patients with pulmonary MDR-TB who received bedaquiline-containing treatment regimens in the Republic of Moldova, a high-burden MDR-TB country.

METHOD:

We systematically analysed the SIMETB national electronic TB database and performed a retrospective propensity score-matched comparison of treatment outcomes in a cohort of patients with MDR-TB who started treatment during 2016-2018 with a bedaquiline-containing regimen (bedaquiline cohort) and a cohort of patients treated without bedaquiline (non-bedaquiline cohort).

RESULTS:

Following propensity score matching, 114 patients were assigned to each cohort of MDR-TB patients. Patients in the bedaquiline cohort had a higher 6-month sputum culture conversion rate than those in the non-bedaquiline cohort (66.7% versus 40.3%; p<0.001). Patients under bedaquiline-containing regimens had a higher cure rate assessed by both World Health Organization (WHO) and TBnet definitions (55.3% versus 24.6%; p=0.001 and 43.5% versus 19.6%; p=0.004, respectively), as well as a lower mortality rate (8.8% versus 20.2%; p<0.001 and 10.9% versus 25.2%; p=0.01, respectively). In patients who previously failed on MDR-TB treatment, >40% of patients achieved a cure with a bedaquiline-containing regimen.

CONCLUSIONS:

Bedaquiline-based MDR-TB treatment regimens result in better disease resolution when compared with bedaquiline-sparing MDR-TB treatment regimens under programmatic conditions in a country with a high burden of MDR-TB.

• Authors: Dumitru Chesov, Jan Heyckendorf, Sofia Alexandru, Ana Donica, Elena Chesov, Maja Reimann, Valeriu Crudu, Victor Botnaru, Christoph Lange
• Journal: The European respiratory journal (Eur Respir J) Vol. 57 Issue 6 (06 2021) ISSN: 1399-3003 [Electronic] England
• PMID: 33334942 (Publication Type: Journal Article)
• Copyright: Copyright ©ERS 2021.

Chemical References

• Antitubercular Agents
• Diarylquinolines
• bedaquiline

Topics

• Antitubercular Agents (therapeutic use)
• Diarylquinolines
• Humans
• Retrospective Studies
• Treatment Outcome
• Tuberculosis, Multidrug-Resistant (drug therapy)