scholarly journals A regimen containing bedaquiline and delamanid compared to bedaquiline in patients with drug-resistant tuberculosis

2019 ◽  
Vol 55 (1) ◽  
pp. 1901181 ◽  
Author(s):  
Olatunde Olayanju ◽  
Aliasgar Esmail ◽  
Jason Limberis ◽  
Keertan Dheda
Keyword(s):  
Combination Group ◽  
Combination Regimen ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Long Term Outcome ◽  
Prognostic Features ◽  
Resistant Tuberculosis ◽  
Significant Difference ◽  
Pre Treatment

There are limited data on combining delamanid and bedaquiline in drug-resistant tuberculosis (DR-TB) regimens. Prospective long-term outcome data, including in HIV-infected persons, are unavailable.We prospectively followed up 122 South African patients (52.5% HIV-infected) with DR-TB and poor prognostic features between 2014 and 2018. We examined outcomes and safety in those who received a bedaquiline-based regimen (n=82) compared to those who received a bedaquiline–delamanid combination regimen (n=40).There was no significant difference in 6-month culture conversion (92.5% versus 81.8%; p=0.26) and 18-month favourable outcome rate (63.4% versus 67.5%; p=0.66) in the bedaquiline versus the bedaquiline–delamanid combination group, despite the latter having more advanced drug resistance (3.7% versus 22.5% resistant to at least five drugs; p=0.001) and higher pre-treatment failure rates (12.2% versus 52.5% with pre-treatment multidrug-resistant TB therapy failure; p<0.001). Although the proportion of prolongation of the QT interval corrected using Fridericia's formula was higher in the combination group (>60 ms from baseline (p=0.001) or >450 ms during treatment (p=0.001)), there were no symptomatic cases or drug withdrawals in either group. Results were similar in HIV-infected patients.A bedaquiline–delamanid combination regimen showed comparable long-term safety compared to a bedaquiline-based regimen in patients with DR-TB, irrespective of HIV status. These data inform regimen selection in patients with DR-TB from TB-endemic settings.

All-oral longer regimens are effective for the management of multidrug resistant tuberculosis in high burden settings

2021 ◽  
pp. 2004345
Author(s):  
Palwasha Y. Khan ◽  
Molly F. Franke ◽  
Catherine Hewison ◽  
Kwonjune J. Seung ◽  
Helena Huerga ◽  
...  
Keyword(s):  
Relative Risk ◽  
World Health ◽  
Potential Contribution ◽  
Adjusted Relative Risk ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis ◽  
Oral Regimen ◽  
Significant Difference ◽  
Culture Conversion

BackgroundRecent World Health Organisation guidance on drug-resistant tuberculosis treatment de-prioritised injectable agents, in use for decades, and endorsed all-oral longer regimens. However, questions remain about the role of the injectable agent, particularly in the context of regimens using new and repurposed drugs. We compared the effectiveness of an injectable-containing regimen to that of an all-oral regimen among patients with drug-resistant tuberculosis who received bedaquiline- and/or delamanid as part of their multidrug regimen.MethodsPatients with a positive baseline culture were included. Six-month culture conversion was defined as two consecutive negative cultures collected >15 days apart. We derived predicted probabilities of culture conversion and relative risk using marginal standardisation methods.ResultsCulture conversion was observed in 83.8% (526/628) of patients receiving an all-oral regimen and 85.5% (425/497) of those receiving an injectable-containing regimen. The adjusted relative risk comparing injectable-containing regimens to all-oral regimens was 0.96 (95%CI: 0.88–1.04). We found very weak evidence of effect modification by HIV status: among patients living with HIV, there was a small increase in the frequency of conversion among those receiving an injectable-containing regimen, relative to an all-oral regimen, which was not apparent in HIV-negative patients.ConclusionsAmong individuals receiving bedaquiline and/or delamanid as part of a multidrug regimen for drug-resistant tuberculosis, there was no significant difference between those who received an injectable and those who did not regarding culture conversion within 6 months. The potential contribution of injectable agents in the treatment of drug-resistant tuberculosis among those who were HIV positive requires further study.

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 Decentralising drug-resistant tuberculosis centre services by offering virtual consultancy- a Kozhikode model

2017 ◽  
Vol 5 (5) ◽  
pp. 1771
Author(s):  
Sunny George ◽  
Rajagopal T. P. ◽  
Annamma P. C. ◽  
James P. T. ◽  
Ravindran Chetambath
Keyword(s):  
The Internet ◽  
Pulmonary Medicine ◽  
Drug Resistant ◽  
Model Group ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis ◽  
Proposed Model ◽  
Mdr Tb ◽  
Feasible Option ◽  
Pre Treatment

Background: Programmatic management of Drug Resistant Tuberculosis (PMDT) recommends one week and one month hospitalisation for pre-treatment evaluation and initiation of second line medications to MDR and XDR patients respectively. Our experience in dealing with these patients prompted us to resort to decentralising DOTs plus services by offering a virtual consultancy to those cases which did not actually require hospitalisation. Aim of the study was to analyze the feasibility of decentralisation strategy adopted in DOTs plus patients to recommend it as a nationwide strategy.Methods: The study was an observational analysis conducted in the Department of Pulmonary Medicine in 373 MDR-TB patients enrolled under DOTs Plus programme for CAT-IV regime during the period between February 2009 and April 2013 and analysed the strategy of decentralization using the internet and expertise of Medical officers at the periphery.Results: The percentage utilisation of virtual consultancy was 83.7% which emphasises the fact that this is a feasible operational modification. Adverse events reported to this DRTB centre were 29.2% in the pre-proposed model period which is comparable to the model group (30.2%).Conclusions: This study shows that in a properly functioning DRTB centre decentralising the services to its peripheral centres is a feasible option utilising the virtual consultancy model as proposed.

Pre-treatment evaluation: Setting a foundation in the management of drug-resistant tuberculosis

2014 ◽  
Vol 2 (2) ◽  
pp. 164
Author(s):  
Saurabh RamBihariLal Shrivastava ◽  
Prateek Saurabh Shrivastava ◽  
Jegadeesh Ramasamy
Keyword(s):  
Treatment Evaluation ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis ◽  
Pre Treatment

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.

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