Bedaquiline-based treatment associated with favorable outcomes in patients with MDR-TB
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Bedaquiline-based regimens for treating patients with multidrug-resistant tuberculosis, MDR-TB, were associated with favorable outcomes and a lower rate of acquired drug resistance compared with delamanid-based regimens, according to a study conducted in the country of Georgia.
“At the time of this study, bedaquiline was approved by the FDA and delamanid by the [European Medicines Agency] for use among certain patients with multidrug-resistant tuberculosis and these medications were eagerly received by the TB community and being implemented into national TB programs, including in the country of Georgia. However, there [were] relatively scarce data on their use and performance in programmatic settings,” Russell Kempker, MD, MSc, assistant professor of medicine in the division of infectious diseases at Emory University School of Medicine, told Infectious Disease News.
“Additionally,” Kempker said, “there [were] no available data comparing outcomes among patients receiving a bedaquiline- vs. delamanid-based regimen, and at the time of this study, it was recommended not to combine these drugs and there was no clear preference for prioritizing either drug. The implementation of bedaquiline and delamanid into MDR-TB treatment regimens in the country of Georgia provided us with a unique opportunity to carry out a comparison of outcomes.”
Kempker and colleagues conducted a prospective, observational study among patients with MDR-TB Georgia at the Georgian National Center for Tuberculosis and Lung Diseases. According to the study, they performed monthly sputum cultures, minimum inhibitory concentration testing and monitored participants for adverse events.
In total, 100 participants with MDR-TB were enrolled, including 64 receiving bedaquiline-based treatment and 31 receiving delamanid-based treatment. Results of the study showed that median effective dose was four in each group, but rates of acquired drug resistance were significantly higher among patients receiving delamanid (36%) compared with those receiving bedaquiline (10%). Additionally, adjusted rates of sputum culture conversion at 2 months (67 vs. 47%) and 6 months (95 vs. 74%) and favorable clinical outcomes (96 vs. 72%) were higher among patients receiving bedaquiline compared with those receiving delamanid.
Kempker said they were “pleasantly surprised to find such a high rate of favorable outcomes among patients with MDR-TB receiving a bedaquiline- or delamanid-based regimen as compared with those seen in prior studies with traditional second-line regimens.”
“The use of new antituberculosis drugs offers excellent new options in the treatment of MDR-TB, and based on our data, bedaquiline-based regimens are especially promising and can achieve extremely high cure rates,” Kempker said. – by Caitlyn Stulpin
Disclosures: The authors report no relevant financial disclosures.
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