Efficacy of Bedaquiline in the Treatment of Drug-resistant Tuberculosis: A Systematic Review and Meta-analysis

Abstract

Background: Drug-resistant TB (DR-TB) remains a major public health concern around the world. Bedaquiline, a novel diarylquinoline, was added into WHO recommended all-oral regimen for patients with multidrug-resistant tuberculosis. We undertook a systematic review and meta-analysis to determine the effect of bedaquiline on tuberculosis treatment outcomes.Methods: We searched for relevant studies in the PubMed, Web of Science and EMBASE database for relevant studies published up to 12 Mar 2021. Stata version 16.0 (Stata Corp., College Station, Texas, USA) was used to analyze results of meta-analysis. For randomized controlled trials, were assessed for quality using the Jadad scale, and cohort studies, using the Newcastle–Ottawa scale.Results: Eight studies including 2 randomized clinical trial and 6 cohort studies involving 21, 836 subjects were included. When compared with control, bedaquiline treatment was associated with higher rates of culture conversion (Risk Ratio (RR) :1.272 (1.165-1.389), P < 0.001). We found substantial evidence that there was significant reduction in all-cause deaths with relative RR = 1.272 (95%CI: 1.165-1.389, P < 0.001) in bedaquiline treatment group. There was no significant reduction in treatment success with RR = 0.980 (90% CI: 0.948-1.013, P = 0.234). Conclusions: This study demonstrated that the use of bedaquiline has the potential to achieve higher culture conversion rate and lower death risk among drug-resistant tuberculosis cases when compared with controls.

Drug resistance patterns, treatment outcomes and factors affecting unfavourable treatment outcomes among extensively drug resistant tuberculosis patients in Pakistan; a multicentre record review

“…This study also found that XDR-TB patients prescribed with bedaquiline had 4.7 times higher chances of unfavourable treatment outcomes as compared to those who were on conventional therapy without bedaquiline. Contrary to this, the use of bedaquiline has been associated with favourable treatment outcomes in many randomized controlled trials ( Ahmad et al, 2018 , Wang et al, 2021 ). Similarly, BPal regimen, - in which bedaquiline is used in combination with other highly effective drugs, including novel pretomanid, - has been approved recently in view of its promising treatment success rates ( Conradie et al, 2020 ).…”

Bedaquiline Correlation to QT Interval Prolongation in DR-TB Patients

“…[4][5][6] Bedaquiline is the main drug in the DR-TB regimen, with the addition of four other drugs based on the patient's sensitivity. 7,8 One of the side effects of Bedaquiline on the heart is the increasing QT interval prolongation incidence that can be seen on an electrocardiogram (ECG). QT intervals refer to ventricular systole cardiac electricity and combine measurement of heart depolarization and repolarization.…”

Bedaquiline resistance probability to guide treatment decision making for rifampicin-resistant tuberculosis: insights from a qualitative study

“…In 2012, Bedaquiline (BDQ) was the first new tuberculosis drug approved by the United States Food and Drug Administration in nearly 50 years. BDQ is a gamechanger for the treatment of rifampicin-resistant tuberculosis (RR-TB) as it enabled the replacement of a long, toxic regimen with a short, all-oral regimen [1][2][3][4]. In the context of the COVID-19 pandemic, the importance of the all-oral regimen has been highlighted since it facilitates home-based care for vulnerable TB patients [5].…”