Bedaquiline-containing regimens and multidrug-resistant tuberculosis: a systematic review and meta-analysis

Abstract

Objective: Multidrug-resistant tuberculosis (MDR-TB) is a life-threatening infectious disease. Treatment requires multiple antimicrobial agents used for extended periods of time. The present study sought to evaluate the treatment success rate of bedaquiline-based regimens in MDR-TB patients. Methods: This was a systematic review and meta-analysis of studies published up to March 15, 2021. The pooled treatment success rates and 95% CIs were assessed with the fixed-effect model or the random-effects model. Values of p < 0.05 were considered significant for publication bias. Results: A total of 2,679 articles were retrieved by database searching. Of those, 29 met the inclusion criteria. Of those, 25 were observational studies (including a total of 3,536 patients) and 4 were experimental studies (including a total of 440 patients). The pooled treatment success rate was 74.7% (95% CI, 69.8-79.0) in the observational studies and 86.1% (95% CI, 76.8-92.1; p = 0.00; I2 = 75%) in the experimental studies. There was no evidence of publication bias (p > 0.05). Conclusions: In patients with MDR-TB receiving bedaquiline, culture conversion and treatment success rates are high even in cases of extensive resistance.

Safety and effectiveness of all-oral and injectable-containing, bedaquiline-based long treatment regimen for pre-XDR tuberculosis in Vietnam

“…Treatment success was similar for both BDQ-long and BDQ/ SLI-long regimens. Overall, 76% success rate for BDQ-based long regimens among highly resistant TB was comparable with findings different settings (Barvaliya et al, 2020;Hatami et al, 2022;Ndjeka et al, 2018). In comparison with the reported treatment success rate of 47% among pre-XDR-TB patients in the program in Vietnam at the same period (Annual NTP report, 2019), the outcomes for BDQ-based long regimens reported in this study were superior.…”

“…Since BDQ was introduced as a new and highly potential anti-TB drug (World Health Organization, 2013) a number of studies have been conducted to assess the outcomes of BDQbased regimens for the treatment of drug-resistant TB. The majority of these studies were about RR-TB treatment while some focused-on smaller cohorts of pre-XDR-TB patients (Hatami et al, 2022). Overall, BDQ-containing regimens showed high culture conversion and treatment success rate among drug-resistant TB patients (Hatami et al, 2022).…”

“…The majority of these studies were about RR-TB treatment while some focused-on smaller cohorts of pre-XDR-TB patients (Hatami et al, 2022). Overall, BDQ-containing regimens showed high culture conversion and treatment success rate among drug-resistant TB patients (Hatami et al, 2022). In its 2020 consolidated guidelines, WHO recommended the use of BDQ as a core drug in all-oral regimens to optimize treatment outcomes and minimize the toxicity of injectable agents (World Health Organization, 2020).…”

“…Moreover, in drug-resistant TB patients with limited treatment options, the exclusion of injectable drugs may lead to a combination of drugs with a similar toxicity profile, for example when multiple QT prolonging drugs, such as fluoroquinolones, clofazimine, and bedaquiline, are used in the same regimen (Brust et al, 2021;Hughes et al, 2022). A number of previous studies described the effectiveness of BDQ-based regimens, with or without SLIs, but only treatment outcomes were assessed (Hatami et al, 2022). How all-oral long regimens (BDQ-long) perform compared to SLI-containing long regimens (BDQ/SLI-long) in terms of safety was less well described.…”

Bedaquiline: A Novel Diarylquinoline for Multidrug-Resistant Pulmonary Tuberculosis

“…A systematic review and meta-analysis published in 2022, considered 25 observational studies and 4 experimental studies where MDR-TB patients were treated with the bedaquiline-containing regimen. This study reported a treatment success rate of 74.4% in observational studies and 86.1% in experimental studies with bedaquiline treatment [ 38 ]. A study evaluated the pharmacokinetic-pharmacodynamic relationship between different antitubercular drugs and their use while selecting drug combinations for DRTB.…”