Outcomes of Bedaquiline Treatment in Patients with Multidrug-Resistant Tuberculosis

Abstract

Bedaquiline is recommended by the World Health Organization for the treatment of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB). We pooled data from 5 cohorts of patients treated with bedaquiline in France, Georgia, Armenia, and South Africa and in a multicountry study. The rate of culture conversion to negative at 6 months (by the end of 6 months of treatment) was 78% (95% CI 73.5%–81.9%), and the treatment success rate was 65.8% (95% CI 59.9%–71.3%). Death rate was 11.7% (95% CI 7.0%–19.1%). Up to 91.1% (95% CI 82.2%–95.8%) of the patients experienced > 1 adverse event, and 11.2% (95% CI 5.0%–23.2%) experienced a serious adverse event. Lung cavitations were consistently associated with unfavorable outcomes. The use of bedaquiline in MDR and XDR TB treatment regimens appears to be effective and safe across different settings, although the certainty of evidence was assessed as very low.

Dynamics of within-hostMycobacterium tuberculosisdiversity and heteroresistance during treatment

“…Overall, clinical outcomes were excellent with similar six-month outcomes in DS and MDR-TB, backing up recent promising observational reports from MDR-TB programmes(58), although six-month outcomes may not fully translate into end of treatment outcomes (59).…”

Strategies in anti-Mycobacterium tuberculosis drug discovery based on phenotypic screening

“…The recent outcomes from five cohorts of patients with MDR-TB treated with bedaquiline for >6 months as a part of standard background regimens reported 78% culture conversion to negative at 6 months, 65.8% treatment success rate and 11.7% death rate. These results compare favorably with those observed in large cohorts of patients with MDR-TB in the pre-bedaquiline era with success rates of 54–58% and death rates of 13.8–15% [18].…”

ERS International Congress, Madrid, 2019: highlights from the Respiratory Infections Assembly

“…Sputum culture conversion was defined as two consecutive negative cultures for TB, collected ⩾30 days apart. Comparable sputum culture conversion rates were reported in other studies with bedaquiline (78%) [55], delamanid (88%) [56] or both (74%) [57].…”