Format

Send to

Choose Destination
Eur Respir J. 2017 May 21;49(5). pii: 1700387. doi: 10.1183/13993003.00387-2017. Print 2017 May.

Effectiveness and safety of bedaquiline-containing regimens in the treatment of MDR- and XDR-TB: a multicentre study.

Author information

1
Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation.
2
These authors contributed equally.
3
UCT Lung Institute, Division of Pulmonology, University of Cape Town, Cape Town, South Africa.
4
Amity Health Consortium, Country Club Estate, Johannesburg, South Africa.
5
Clinical Unit, District Clinical Specialist Team, Springbok, South Africa.
6
World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy.
7
Public Health Consulting Group, Lugano, Switzerland.
8
Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari, Sassari, Italy.
9
Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK.
10
Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
11
University of Groningen, University Medical Center Groningen, Dept of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands.
12
Northern State Medical University, Arkhangelsk, Russian Federation.
13
Dept of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, India.
14
Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus.
15
University of Groningen, University Medical Center Groningen, Tuberculosis Center Beatrixoord, Haren, The Netherlands.
16
University of Groningen, University Medical Center Groningen, Dept of Pulmonary Diseases and Tuberculosis, Groningen, The Netherlands.
17
Dept of Phthisiology, Grodno State Medical University, GRCC "Phthisiology", Grodno, Belarus.
18
Unit of Infectious Diseases, Dept of Medicine, Solna, Karolinska Institute, Dept of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
19
Pneumology Dept, Hospital General de Gran Canaria "Dr Negrin", Las Palmas de Gran Canaria, Spain.
20
MDR-TB Unit, Tuberculosis Division, International Union against Tuberculosis and Lung Disease (The Union), Paris, France.
21
General University Hospital Morales Meseguer, Murcia, Spain.
22
TB Reference Centre, Villa Marelli Institute/Niguarda Hospital, Milan, Italy.
23
Hélio Fraga Reference Center, Fiocruz/MoH, Rio de Janeiro, Brazil.
24
Victorian Tuberculosis Program, Melbourne Health, Dept of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
25
Health Policy and Performance Branch, Health Services and Policy Division, Dept of Immigration and Border Protection, Sydney, Australia.
26
National Reference Centre for MDR-TB, Hospital Centre Vila Nova de Gaia, Dept of Pneumology, Public Health Science and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal.
27
UCT Lung Institute, Lung Infection and Immunity Unit, Division of Pulmonology, Dept of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.
28
7th Respiratory Medicine Dept, Athens Chest Hospital, Athens, Greece.
29
Bronchiectasis Unit, Respiratory Dept, Hospital Universitario Araba, Vitoria-Gasteiz, Spain.
30
Tuberculosis Research Programme, SEPAR, Barcelona, Spain.
31
Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy.
32
National TB Surveillance Unit, Public Health Agency, Stockholm, Sweden.
33
Dept of Infectious Diseases, Box Hill Hospital, Victoria, Australia.
34
Harry Surtie Hospital, Upington, South Africa.
35
Dept of Infectious Diseases, University National San Antonio Abad Cusco, Cusco, Perù.
36
Pulmonary Dept, 'G. Papanikolaou' Hospital, Aristotle University, Thessaloniki, Greece.
37
Pulmonology Division, Municipal Hospital F. J. Munĩz, Buenos Aires, Argentina.
38
Pneumology Dept, University of Insubria, Varese, Italy.
39
AOVV Eugenio Morelli Hospital, Reference Hospital for MDR and HIV-TB, Sondalo, Italy.
40
MDR-TB Unit, Athens Chest Hospital, Ministry of Health, Athens, Greece.
41
Division of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium.
42
Dept of Infectious Diseases, Galliera Hospital, Genoa, Italy.
43
Coimbra Medical School, Pneumology Dept, Coimbra University Hospital, Coimbra, Portugal.
44
Delek Hospital, Dharamshala, India.
45
Pneumology Dept, Maugeri Care and Research Institute, Tradate, Italy.
46
Dept of Clinical and Experimental Medicine, University of Insubria, Varese, Italy.
47
University Hospital San Martino, Care and Research Institute, National Institute for Cancer Research, Genoa, Italy.
48
Dept of Infectious Diseases, Western Hospital, Victoria, Australia.
49
Dept of Respiratory Medicine, Barts Healthcare NHS Trust, London, UK.
50
Division of Infection and Immunity, University College London and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK.
51
World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy giovannibattista.migliori@icsmaugeri.it.

Abstract

Large studies on bedaquiline used to treat multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB) are lacking. This study aimed to evaluate the safety and effectiveness of bedaquiline-containing regimens in a large, retrospective, observational study conducted in 25 centres and 15 countries in five continents.428 culture-confirmed MDR-TB cases were analysed (61.5% male; 22.1% HIV-positive, 45.6% XDR-TB). MDR-TB cases were admitted to hospital for a median (interquartile range (IQR)) 179 (92-280) days and exposed to bedaquiline for 168 (86-180) days. Treatment regimens included, among others, linezolid, moxifloxacin, clofazimine and carbapenems (82.0%, 58.4%, 52.6% and 15.3% of cases, respectively).Sputum smear and culture conversion rates in MDR-TB cases were 63.6% and 30.1%, respectively at 30 days, 81.1% and 56.7%, respectively at 60 days; 85.5% and 80.5%, respectively at 90 days and 88.7% and 91.2%, respectively at the end of treatment. The median (IQR) time to smear and culture conversion was 34 (30-60) days and 60 (33-90) days. Out of 247 culture-confirmed MDR-TB cases completing treatment, 71.3% achieved success (62.4% cured; 8.9% completed treatment), 13.4% died, 7.3% defaulted and 7.7% failed. Bedaquiline was interrupted due to adverse events in 5.8% of cases. A single case died, having electrocardiographic abnormalities that were probably non-bedaquiline related.Bedaquiline-containing regimens achieved high conversion and success rates under different nonexperimental conditions.

PMID:
28529205
DOI:
10.1183/13993003.00387-2017
[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center