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.

Keywords: 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.

Figure

Summary of treatment outcomes and adverse events in study of bedaquiline treatment for multidrug-resistant tuberculosis. Values are shown as percent with 95% CI, shown in the graph as horizontal bars. QTcF indicates QT intervals corrected for heart rate using the Fridericia formula. * A total of 406 study participants with culture data at the 6-month point; †, a total of 509 participants with baseline QTcF data.