scholarly journals Long-term bedaquiline-related treatment outcomes in patients with extensively drug-resistant tuberculosis from South Africa

2018 ◽  
Vol 51 (5) ◽  
pp. 1800544 ◽  
Author(s):  
Olatunde Olayanju ◽  
Jason Limberis ◽  
Aliasgar Esmail ◽  
Suzette Oelofse ◽  
Phindile Gina ◽  
...  
Keyword(s):  
Outcome Data ◽  
Favourable Outcome ◽  
Cd4 Count ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Treatment Regimens ◽  
Resistant Tuberculosis ◽  
Extensively Drug Resistant ◽  
African Patients

Optimal treatment regimens for patients with extensively drug-resistant tuberculosis (XDR-TB) remain unclear. Long-term prospective outcome data comparing XDR-TB regimens with and without bedaquiline from an endemic setting are lacking.We prospectively followed-up 272 South African patients (49.3% HIV-infected; median CD4 count 169 cells·µL−1) with newly diagnosed XDR-TB between 2008 and 2017. Outcomes were compared between those who had not received bedaquiline (pre-2013; n=204) and those who had (post-2013; n=68; 80.9% received linezolid in addition).The 24-month favourable outcome rate was substantially better in the bedaquiline versus the non-bedaquiline group (66.2% (45 out of 68) versus 13.2% (27 out of 204); p<0.001). In addition, the bedaquiline group exhibited reduced 24-month rates of treatment failure (5.9% versus 26.0%; p<0.001) and default (1.5% versus 15.2%; p<0.001). However, linezolid was withdrawn in 32.7% (18 out of 55) of patients in the bedaquiline group because of adverse events. Admission weight >50 kg, an increasing number of anti-TB drugs and bedaquiline were independent predictors of survival (the bedaquiline survival effect remained significant in HIV-infected persons, irrespective of CD4 count).XDR-TB patients receiving a backbone of bedaquiline and linezolid had substantially better favourable outcomes compared to those not using these drugs. These data inform the selection of XDR-TB treatment regimens and roll-out of newer drugs in TB-endemic countries.

Treatment of patients with multidrug­resistant and extensively drug resistant tuberculosis depending on the composition of individualized regimens: immediate and long­term results

2021 ◽  
pp. 7-15
Author(s):  
Yu.I. Feshchenko ◽  
N.A. Litvinenko ◽  
N.V. Grankina ◽  
M.V. Pogrebna ◽  
Yu.O. Senko ◽  
...  
Keyword(s):  
Effective Treatment ◽  
Treatment Effectiveness ◽  
Individualized Treatment ◽  
Fluoroquinolone Resistance ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Treatment Regimens ◽  
Resistant Tuberculosis ◽  
Extensively Drug Resistant

Objective — to study the effectiveness of treatment of MDR-TB (multidrug-resistant tuberculosis) and preXDR-TB/XDR-TB (pre-extensively and extensively drug resistant tuberculosis), depending on the composition of ITRs (individualized treatment regimens). Materials and methods. Тhe prospective observational study included 566 patients with MDR/preXDR-TB and XDR-TB during 2016—2020 on the scientific clinical bases of the SI «National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky NAMS of Ukraine» and ME «Kryvyi Rih Anti-tuberculosis Dispensary» Dnipropetrovsk Regional Council Department. Patients were prescribed individualized treatment regimens in cases where short (standard or modified) regimens could not be prescribed. Patients were divided into comparison groups: 469 of them were treated with antimycobacterial therapy including bedaquiline and other effective antimycobacterial drugs groups A—C (without delamanid) — group 1. And 97 patients who were treated with the inclusion of both new antimycobacterial drugs (bedaquiline and delamanid) — group 2. Results and discussion. Regardless of whether the delamanid, in addition to bedaquiline and other drugs selected for the scheme according to WHO recommendations, «effective treatment» was found in 91.3 against 88.6 % of patients. In the remote period (6-month — 4-year follow-up period) there was no recurrence of the disease, regardless of the composition of the regime. The loss of treatment effectiveness was due to deaths from non-tuberculosis reasons and those lost for follow-up. Conclusions. For highly effective treatment, individualized regimens should include bedaquidine and linezolid from group A, and for previously ineffectively treated patients, clofazimine and carbapenems must be included (possibility to include 4 or more effective AMDs in ITR). For patients with fluoroquinolone resistance, treatment should include delamanid.

Long-term outcomes of patients with extensively drug-resistant tuberculosis in South Africa: a cohort study

The Lancet ◽  
2014 ◽  
Vol 383 (9924) ◽  
pp. 1230-1239 ◽  
Author(s):  
Elize Pietersen ◽  
Elisa Ignatius ◽  
Elizabeth M Streicher ◽  
Barbara Mastrapa ◽  
Xavier Padanilam ◽  
...  
Keyword(s):  
South Africa ◽  
Cohort Study ◽  
Drug Resistant ◽  
Long Term Outcomes ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis ◽  
Extensively Drug Resistant

scholarly journals Linezolid use for drug-resistant tuberculosis in Georgia: a retrospective cohort study

2020 ◽  
Vol 24 (4) ◽  
pp. 436-443 ◽  
Author(s):  
L. Mikiashvili ◽  
M. Kipiani ◽  
M. C. Schechter ◽  
Z. Avaliani ◽  
N. Kiria ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Retrospective Cohort ◽  
Drug Resistant ◽  
Treatment Regimens ◽  
Resistant Tuberculosis ◽  
Extensively Drug Resistant ◽  
Country Of Georgia ◽  
Almost All ◽  
Culture Conversion

SETTING: Data on the long-term use of linezolid (LZD) in the treatment of drug-resistant pulmonary tuberculosis (DR-PTB) are limited.OBJECTIVE: To assess safety, tolerability and efficacy of LZD-containing regimens for the treatment of DR-PTB in the country of Georgia.DESIGN: A retrospective study was conducted among DR-PTB patients receiving LZD 600 mg/day as part of newly implemented regimens (bedaquiline or delamanid, repurposed and second-line drugs) from July 2014 to October 2015 in programmatic conditions and following WHO recommendations.RESULTS: One hundred mostly male (82%) patients with a median age of 33 years received LZD. Most patients (77%) had previously been treated for TB; 57% had extensively drug-resistant TB. The median duration of LZD use was 503 days (interquartile range 355–616). LZD-associated adverse events occurred in 12 patients, leading to discontinuation in 4 (2 each due to peripheral neuropathy and cytopenias), and dose reduction to 300 mg/day in 6 cases (4 due to peripheral neuropathy and 2 for cytopenias). Almost all patients (95%) achieved culture conversion and 79% had a successful treatment outcomes.CONCLUSION: Treatment regimens including lengthy LZD use showed fairly good safety and tolerability and were associated with high rates of culture conversion and favorable outcomes.

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