Outcomes of Bedaquiline Treatment in Patients with Multidrug-Resistant Tuberculosis.

Auteurs: Mbuagbaw L Guglielmetti L Hewison C Bakare N Bastard M Caumes E Fréchet-Jachym M Robert J Veziris N Khachatryan N Kotrikadze T Hayrapetyan A Avaliani Z Schünemann HJ Lienhardt C
Référence de l'article: Emerging infectious diseases 2019 May ; 25(5); 936-943. doi: 10.3201/eid2505.181823. Epub 2019 04 19
Armenia Asia China Europe France Georgia MDR South Africa TB XDR antimicrobial resistance bacteria bedaquiline extensively drug resistant individual patient data multidrug resistant tuberculosis tuberculosis and other mycobacteria
eng

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.