Berita Kesehatan
A regimen containing bedaquiline and delamanid compared to bedaquiline in patients
Sabtu, 30 Nov 2019 09:43:18

Olatunde Olayanju, Aliasgar Esmail, Jason Limberis, Keertan Dheda

European Respiratory Journal 2019; DOI: 10.1183/13993003.01181-2019

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

Abstract

There are limited data about 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 Africans (52.5% HIV-infected) with DR-TB and poor prognostic features between 2014 and 2018. We compared outcomes and safety in those who received a bedaquiline-based regimen (n=82) 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 >5 drugs; p=0.001) and higher pre-treatment failure rates (12.2% versus 52.5% with pre-treatment MDR-TB therapy failure; p<0.001). Although the proportion of QTcF prolongation 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 withdrawal in either group. Results were similar in HIV-infected patients.

A bedaquiline-delamanid combination regimen showed comparable long-term safety, 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.

Footnotes

This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

Conflict of interest: I have no conflict of interest to declare

Conflict of interest: I have no conflict of interest to declare

Conflict of interest: I have no conflict of interest to declare

Conflict of interest: I have no conflict of interest to declare

  • Received June 16, 2019.
  • Accepted October 9, 2019.
  • Copyright ©ERS 2019