Favorable Outcome of Individual Regimens Containing Bedaquiline and Delamanid in Drug-Resistant Tuberculosis: A Systematic Review

Abstract

Background: Drug-resistant tuberculosis (DR-TB) is a public health concern that is difficult to treat, requiring long and complex treatment with highly effective drugs. Bedaquiline and/or delamanid have already shown promising outcomes in patients with DR-TB, increasing the rate of culture conversion and lowering TB-related mortality. Methods: We comprehensively searched and evaluated the effectiveness of individual regimens containing bedaquiline and delamanid on culture conversion and treatment success. We assessed for quality either observational or experimental studies. Results: We identified 14 studies that met the inclusion criteria using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart with 12 observational and 2 experimental studies. Of 1691 DR-TB patients enrolled in the included studies, 1407 of them concomitantly received regimens containing bedaquiline and delamanid. Overall multidrug resistant (MDR), preextensively drug resistant (XDR), and XDR-TB were seen in 21.4%, 44.1%, and 34.5%, respectively. Of 14 studies, 8 of them reported favorable outcomes including sputum culture conversion and cure rate at the end of treatment, meanwhile 6 studies only reported sputum culture conversion. Sputum culture conversion at the end of the 6th month was 63.6%–94.7% for observational studies, and 87.6%–95.0% for experimental studies. The favorable outcome at the end of treatment was 67.5%–91.4%. With high pre-XDR and XDR cases among DR-TB patients with limited treatment options, regimens containing bedaquiline and delamanid provide successful treatment. Conclusion: In DR-TB patients receiving regimens containing bedaquiline and delamanid, favorable outcomes were high including sputum conversion and cure rate.

Treatment Outcomes of Fluoroquinolone-Resistant Multidrug-Resistant Tuberculosis: An Implication for Delamanid

“…Overall, the treatment success rate was 69.7% among the pre-XDR TB patients [ 1 ]. Our previous study reported that in DR-TB patients who received regimens containing bedaquiline and delamanid, favorable outcomes (treatment success and treatment completion) at the end of treatment ranged from 67.5% to 91.4% [ 9 ]. Furthermore, a study in South Korea by Kang et al [ 10 ] and Hwang et al [ 11 ], demonstrated that regimens containing bedaquiline and/or delamanid showed highly favorable outcomes without any significant differences in adverse events in MDR, pre-XDR, and XDR-TB patients.…”

“…It could represent a new treatment option to improve compliance in patients with fluoroquinolone-sensitive MDR-TB. However, concomitant use of bedaquiline and delamanid is rare in clinical settings due to their potential adverse events, such as corrected QT (QTc) prolongation [ 9 ]. Therefore, measurement of QTc interval should be closely supervised during these treatments.…”