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Identification of patients who could benefit from bedaquiline or delamanid: a multisite MDR-TB cohort study

  • 2016/02/01
Type of publication
  • Articles
Authors
  • Bonnet M
  • Bastard M
  • du Cros P
  • Khamraev A
  • Kimenye K
  • Khurkhumal S
  • Hayrapetyan A
  • Themba D
  • Telnov A
  • Sanchez-Padilla E
  • Hewison C
  • Varaine F
Themes
  • Tuberculose

Abstract

BACKGROUND:

The World Health Organization recommends adding bedaquiline or delamanid to multidrug-resistant tuberculosis (MDR-TB) regimens for which four effective drugs are not available, and delamanid for patients at high risk of poor outcome.

OBJECTIVE:

To identify patients at risk of unfavourable outcomes who may benefit from the new drugs.

METHODS:

Retrospective cohort study of treatment outcomes involving four to five effective drugs for 15-24 months in programmes in Uzbekistan, Georgia, Armenia, Swaziland and Kenya between 2001 and 2011.

RESULTS:

Of 1433 patients, 48.5% had body mass index (BMI) <18.5 kg/m(2), 72.9% had a high bacillary load, 16.7% were resistant to two injectables, 2.9% were resistant to ofloxacin (OFX) and 3.0% had extensively drug-resistant TB (XDR-TB). Treatment success ranged from 59.7% (no second-line resistance) to 27.0% (XDR-TB). XDR-TB (aOR 8.16, 95%CI 3.22-20.64), resistance to two injectables (aOR 1.90, 95%CI 1.00-3.62) or OFX (aOR 5.56, 95%CI 2.15-14.37), past incarceration (aOR 1.88, 95%CI 1.11-3.2), history of second-line treatment (aOR 3.24, 95%CI 1.53-6.85), low BMI (aOR 2.22, 95%CI 1.56-3.12) and high bacillary load (aOR 2.32, 95%CI 1.15-4.67) were associated with unfavourable outcomes. Patients started on capreomycin rather than kanamycin were more likely to have an unfavourable outcome (aOR 1.54, 95%CI 1.04-2.28).

CONCLUSION:

In our cohort, patients who may benefit from bedaquiline and delamanid represented up to two thirds of all MDR-TB patients.