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Ur Rehman O, Fatima E, Ali A, Akram U, Nashwan A, Yunus F. Efficacy and safety of bedaquiline containing regimens in patients of drug-resistant tuberculosis: An updated systematic review and meta-analysis. J Clin Tuberc Other Mycobact Dis 2024; 34:100405. [PMID: 38152568 PMCID: PMC10750101 DOI: 10.1016/j.jctube.2023.100405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Background Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis and leads to serious complications if left untreated. Some strains of Mycobacterium tuberculosis are multi-drug resistant and require treatment with newer drugs. Bedaquiline based treatment regimens have been used in patients who are diagnosed with drug resistant tuberculosis. The aim of this study is to assess the efficacy and safety profile of bedaquiline-based treatment regimens using a systematic review of existing literature and meta-analysis. Methods In this study, an electronic search was carried out on PubMed, ScienceDirect, and Cochrane library to find relevant literature from March 2021 onwards. Random-effects model was used to assess pooled treatment success rate and 95 % CIs. p-value of <0.05 was suggestive of publication bias. The review is registered with PROSPERO: CRD42023432748. Results A total of 543 articles were retrieved by database searching, out of which 12 new studies met the inclusion criteria. The total number of articles included in the review was 41 including 36 observational studies (having a total of 9,934 patients) and 5 experimental studies (having a total of 468 patients). The pooled treatment success rate was 76.9 % (95 % CI, 72.9-80.4) in the observational studies and 81.7 % (95 % CI, 67.2-90.7) in the experimental studies. Further subgroup analysis was done on the basis of treatment regimens containing bedaquiline only and treatment regimens containing bedaquiline and delamanid. The pooled treatment success rate in the studies consisting of patients who were treated with regimens containing bedaquiline only was 78.4 % (95 % CI, 74.2-82.1) and 73.6 % (95 % CI, 64.6-81.0) in studies consisting of patients who were treated with regimens containing bedaquiline and delamanid. There was no evidence of publication bias. Conclusions In patients of drug resistant tuberculosis having highly resistant strains of Mycobacterium tuberculosis undergoing treatment with bedaquiline-based regimen demonstrate high rates of culture conversion and treatment success. Moreover, the safety profile of bedaquiline-based regimens is well-established in all studies.
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Affiliation(s)
- Obaid Ur Rehman
- Department of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Eeshal Fatima
- Department of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Abraish Ali
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Umar Akram
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | | | - Faryal Yunus
- Department of Pathology, Services Institute of Medical Sciences, Lahore, Pakistan
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Ahmed SH, Haider H, Moeed A, Mahmood A, Shivani N, Shuja SH, Hayat J, Jamil B, Fatima R. Efficacy and safety of bedaquiline and delamanid in the treatment of drug-resistant tuberculosis in adults: A systematic review and meta-analysis. Indian J Tuberc 2024; 71:79-88. [PMID: 38296395 DOI: 10.1016/j.ijtb.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/21/2023] [Accepted: 05/10/2023] [Indexed: 02/15/2024]
Abstract
Multi and extensively drug-resistant tuberculosis is a grave cause of global public health concern due to its high mortality and limited treatment options. We conducted this systemic review and meta-analysis to evaluate the efficacy and safety of bedaquiline and delamanid, which have been added to the WHO-recommended regimen for treating drug-resistant tuberculosis. Electronic databases were searched from their inception until December 1st, 2021, for eligible studies assessing the efficacy and safety of bedaquiline and delamanid for treating drug-resistant tuberculosis. Binary outcomes were pooled using a DerSimonian-Laird random-effects model and arcsine transformation and reported on a log scale with a 95% confidence interval (CIs). Twenty-one studies were shortlisted in which bedaquiline, delamanid, and a combination of both were administered in 2477, 937, and 169 patients. Pooled culture conversion at 6 months was 0.801 (p < 0.001), 0.849 (p = 0.059) for bedaquiline and delamanid, respectively, and 0.823 (p = 0.017), concomitantly. In the bedaquiline cohort, the pooled proportion of all-cause mortality at 6 months was reported as 0.074 (p < 0.001), 0.031 (p = 0.372) in the delamanid cohort, and 0.172 in the combined cohort. The incidence of adverse events in the bedaquiline cohort ranged from 11.1% to 95.2%, from 13.2% to 86.2% in the delamanid cohort, and 92.5% in a study in the combined cohort. The incidence of QTC prolongation reported in each cohort is as follows: bedaquiline 0.163 (p < 0.001), delamanid 0.344 (p = 0.272) and combined 0.340 (p < 0.001). Our review establishes the efficacy of delamanid, bedaquiline, and their combined use in treating drug-resistant tuberculosis with reasonable rates of culture conversion, low mortality rates, and safety of co-administration, as seen with their effect on the QTc interval.
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Affiliation(s)
- Syeda Hoorulain Ahmed
- Department of Internal Medicine, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi, 74200, Pakistan.
| | - Hoorain Haider
- Department of Internal Medicine, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi, 74200, Pakistan
| | - Abdul Moeed
- Department of Internal Medicine, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi, 74200, Pakistan
| | - Aysal Mahmood
- Department of Internal Medicine, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi, 74200, Pakistan
| | - Nasir Shivani
- Department of Medicine, Bedford Hospital, Bedford, Bedfordshire, United Kingdom
| | - Syed Hasan Shuja
- Department of Internal Medicine, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi, 74200, Pakistan
| | - Javeria Hayat
- Department of Internal Medicine, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi, 74200, Pakistan
| | - Bushra Jamil
- Department of Medicine, Aga Khan University, National Stadium Road, Karachi, 74800, Pakistan
| | - Razia Fatima
- Common Management Unit (TB, HIV/AIDS & Malaria), Islamabad, Pakistan
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Rai DK, Sharma P. Palliative Care in Drug Resistance Tuberculosis: An Overlooked Component in Management. Indian J Palliat Care 2023; 29:388-393. [PMID: 38058485 PMCID: PMC10696341 DOI: 10.25259/ijpc_141_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/10/2023] [Indexed: 12/08/2023] Open
Abstract
Palliative care should be an important component in the management of drug resistant tuberculosis (DRTB); however, it is not given much importance. Even in the current scenario, many patients and their caregivers consider multidrug-resistant and extensively drug-resistant tuberculosis (TB) as a terminal illness and considering it almost as a death sentence, this group of patients also require palliative care. There is a misconception about considering palliative care as a treatment component in the terminal stage of an illness where curative treatment has no role in improving the survival of the patient. However, the real meaning of palliative care is to relieve suffering in all stages of the disease and is not limited to end-of-life care only. Palliative care in DRTB aims to improve the quality of life, intractable symptoms and physical, psychosocial and spiritual suffering of patients as well as their caregivers. There is an imminent need to train all TB healthcare workers regarding basic palliative care and integrate palliative care into the TB healthcare system.
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Affiliation(s)
- Deependra Kumar Rai
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Priya Sharma
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
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Mary Prince R, Khangarot S, Haque QF, Mittal A, Somani R, Grover M. Outcomes of bedaquiline-containing regimen in the treatment of adults with drug-resistant tuberculosis in a tertiary care center in Rajasthan. Monaldi Arch Chest Dis 2023; 94. [PMID: 37551096 DOI: 10.4081/monaldi.2023.2618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/06/2023] [Indexed: 08/09/2023] Open
Abstract
The emergence of drug-resistant strains of Mycobacterium tuberculosis has become a significant public health problem and has led to a setback in the efforts to end tuberculosis (TB) worldwide. The longer duration, heavier pill load, and higher toxicity profile of drug-resistant TB regimens compared to those for drug-susceptible TB lead to reduced adherence and worse treatment results, including mortality. This study was conducted to estimate treatment outcomes and adverse effects in patients with drug-resistant TB on a bedaquiline-containing regimen. Patients after the pre-treatment evaluation were enrolled in a bedaquiline-containing regimen. These patients were followed up for 18 months, and the final outcome was assessed along with the adverse effects. It was found that 49 (84.4%) patients achieved culture conversion by 3 months, 54 (93.1%) achieved culture conversion by 6 months, 52 (83.81%) had favorable outcomes (cured, treatment completed), and 10 had unfavorable outcomes (died, lost to follow-up, failed). Coupled with gradually increasing trends in success rates since 2012, lesser failure rates and fewer concerns regarding grave adverse effects are a silver lining in the cloud of increasing burden and widening resistance patterns. More funding has to be directed towards ensuring adherence and finding high-risk individuals to expedite the achievement of sustainable development goals.
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Affiliation(s)
| | - Suman Khangarot
- Department of Respiratory Medicine, Government Medical College, Kota.
| | | | - Anish Mittal
- Department of Respiratory Medicine, Government Medical College, Kota.
| | - Ramdhan Somani
- Department of Respiratory Medicine, Government Medical College, Kota.
| | - Mansha Grover
- Department of Respiratory Medicine, Government Medical College, Kota.
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Hatami H, Sotgiu G, Bostanghadiri N, Abadi SSD, Mesgarpour B, Goudarzi H, Migliori GB, Nasiri MJ. Bedaquiline-containing regimens and multidrug-resistant tuberculosis: a systematic review and meta-analysis. J Bras Pneumol 2022; 48:e20210384. [PMID: 35649043 PMCID: PMC8836629 DOI: 10.36416/1806-3756/e20210384] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/30/2021] [Indexed: 12/01/2022] Open
Abstract
Objective: Multidrug-resistant tuberculosis (MDR-TB) is a life-threatening infectious disease. Treatment requires multiple antimicrobial agents used for extended periods of time. The present study sought to evaluate the treatment success rate of bedaquiline-based regimens in MDR-TB patients. Methods: This was a systematic review and meta-analysis of studies published up to March 15, 2021. The pooled treatment success rates and 95% CIs were assessed with the fixed-effect model or the random-effects model. Values of p < 0.05 were considered significant for publication bias. Results: A total of 2,679 articles were retrieved by database searching. Of those, 29 met the inclusion criteria. Of those, 25 were observational studies (including a total of 3,536 patients) and 4 were experimental studies (including a total of 440 patients). The pooled treatment success rate was 74.7% (95% CI, 69.8-79.0) in the observational studies and 86.1% (95% CI, 76.8-92.1; p = 0.00; I2 = 75%) in the experimental studies. There was no evidence of publication bias (p > 0.05). Conclusions: In patients with MDR-TB receiving bedaquiline, culture conversion and treatment success rates are high even in cases of extensive resistance.
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Affiliation(s)
- Hossein Hatami
- . Department of Public Health, School of Public Health and Safety; Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Giovanni Sotgiu
- . Unità di Epidemiologia Clinica e Statistica Medica, Dipartimento di Scienze Mediche Chirurgiche e Sperimentali, Università degli Studi di Sassari, Sassari, Italia
| | - Narjess Bostanghadiri
- . Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sahel Shafiee Dolat Abadi
- . Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bita Mesgarpour
- . Department of Public and International Affairs, National Institute for Medical Research Development - NIMAD - Tehran, Iran
| | - Hossein Goudarzi
- . Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Javad Nasiri
- . Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Gao JT, Du J, Wu GH, Pei Y, Gao MQ, Martinez L, Fan L, Chen W, Xie L, Chen Y, Wang H, Jin L, Li GB, Zong PL, Xiong Y, Wu QH, Li MW, Yan XF, Miao YF, Cai QS, Li XJ, Bai DP, Geng SJ, Yang GL, Tang PJ, Zeng Y, Chen XH, Li TX, Cai C, Zhou Y, Zhuo M, Wang JY, Guan WL, Xu L, Shi JC, Shu W, Cheng LL, Teng F, Ning YJ, Xie SH, Sun YX, Zhang LJ, Liu YH. Bedaquiline-containing regimens in patients with pulmonary multidrug-resistant tuberculosis in China: focus on the safety. Infect Dis Poverty 2021; 10:32. [PMID: 33736710 PMCID: PMC7977294 DOI: 10.1186/s40249-021-00819-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/05/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND World Health Organization recommends countries introducing new drug and short treatment regimen for drug resistant tuberculosis (DR-TB) should develop and implement a system for active pharmacovigilance that allows for detection, reporting and management of adverse events. The aim of the study is to evaluate the frequency and severity of adverse events (AEs) of bedaquiline-containing regimen in a cohort of Chinese patients with multidrug-resistant (MDR)/extensively drug-resistant (XDR)-TB based on active drug safety monitoring (aDSM) system of New Drug Introduction and Protection Program (NDIP). METHODS AEs were prospectively collected with demographic, bacteriological, radiological and clinical data from 54 sites throughout China at patient enrollment and during treatment between February, 2018 and December, 2019. This is an interim analysis including patients who are still on treatment and those that have completed treatment. A descriptive analysis was performed on the patients evaluated in the cohort. RESULTS By December 31, 2019, a total of 1162 patients received bedaquiline-containing anti-TB treatment. Overall, 1563 AEs were reported, 66.9% were classified as minor (Grade 1-2) and 33.1% as serious (Grade 3-5). The median duration of bedaquiline treatment was 167.0 [interquartile range (IQR): 75-169] days. 86 (7.4%) patients received 36-week prolonged treatment with bedaquiline. The incidence of AEs and serious AEs was 47.1% and 7.8%, respectively. The most frequently reported AEs were QT prolongation (24.7%) and hepatotoxicity (16.4%). There were 14 (1.2%) AEs leading to death. Out of patients with available corrected QT interval by Fridericia's formula (QTcF) data, 3.1% (32/1044) experienced a post-baseline QTcF ≥ 500 ms, and 15.7% (132/839) had at least one change of QTcF ≥ 60 ms from baseline. 49 (4.2%) patients had QT prolonged AEs leading to bedaquiline withdrawal. One hundred and ninety patients reported 361 AEs with hepatotoxicity ranking the second with high occurrence. Thirty-four patients reported 43 AEs of hepatic injury referred to bedaquiline, much lower than that referred to protionamide, pyrazinamide and para-aminosalicylic acid individually. CONCLUSIONS Bedaquiline was generally well-tolerated with few safety concerns in this clinical patient population without any new safety signal identified. The mortality rate was generally low. These data inform significant positive effect to support the WHO recent recommendations for the wide use of bedaquiline.
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Affiliation(s)
- Jing-Tao Gao
- Clinical Center on TB, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, No 9, Beiguan Street, Tongzhou District, Beijing, 101149, People's Republic of China
| | - Juan Du
- Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan, People's Republic of China
| | - Gui-Hui Wu
- Department of Tuberculosis, Chengdu Public Health Clinical Center, Chengdu, People's Republic of China
| | - Yi Pei
- Department of Tuberculosis, Changsha Central Hospital, Changsha, People's Republic of China
| | - Meng-Qiu Gao
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, People's Republic of China
| | - Leonardo Martinez
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Lin Fan
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Shanghai, People's Republic of China
| | - Wei Chen
- Department of Tuberculosis, Shenyang Chest Hospital, Shenyang, People's Republic of China
| | - Li Xie
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, People's Republic of China
| | - Yu Chen
- Department of Tuberculosis, The Sixth People's Hospital of Zhengzhou, Zhengzhou, People's Republic of China
| | - Hua Wang
- Department of Tuberculosis, Anhui Chest Hospital, Hefei, People's Republic of China
| | - Long Jin
- Department of Tuberculosis, Infectious Diseases Hospital Heilongjiang Province, Harbin, People's Republic of China
| | - Guo-Bao Li
- Department of Tuberculosis, The Third People's Hospital of Shenzhen, Shenzhen, People's Republic of China
| | - Pei-Lan Zong
- Department of Tuberculosis, Jiangxi Chest (Third People) Hospital, Nanchang, People's Republic of China
| | - Yu Xiong
- Department of Tuberculosis, Shandong Provincial Chest Hospital, Jinan, People's Republic of China
| | - Qian-Hong Wu
- Department of Tuberculosis, Shanxi Provincial Tuberculosis Institute, Xi'an, People's Republic of China
| | - Ming-Wu Li
- Department of Tuberculosis, Kunming Third People's Hospital, Kunming, People's Republic of China
| | - Xiao-Feng Yan
- Department of Tuberculosis, Chongqing Public Health Medical Center, Chongqing, People's Republic of China
| | - Yan-Fang Miao
- Department of Tuberculosis, The Fourth People's Hospital of Taiyuan, Taiyuan, People's Republic of China
| | - Qing-Shan Cai
- Department of Tuberculosis, Hangzhou Red Cross Hospital, Hangzhou, People's Republic of China
| | - Xin-Jie Li
- Department of Tuberculosis, Guangzhou Chest Hospital, Guangzhou, People's Republic of China
| | - Da-Peng Bai
- Department of Tuberculosis, Tianjin Haihe Hospital, Tianjin, People's Republic of China
| | - Shu-Jun Geng
- Department of Tuberculosis, Hebei Chest Hospital, Shijiazhuang, People's Republic of China
| | - Guo-Li Yang
- Department of Tuberculosis, Tuberculosis Hospital of Jilin Province, Changchun, People's Republic of China
| | - Pei-Jun Tang
- Department of Tuberculosis, The Fifth People's Hospital of Suzhou, Infectious Disease Hospital, Affiliated to Soochow University, Suzhou, People's Republic of China
| | - Yi Zeng
- Department of Tuberculosis, The Second Hospital of Nanjing, Nanjing, People's Republic of China
| | - Xiao-Hong Chen
- Department of Tuberculosis, Fuzhou Pulmonary Hospital of Fujian, Fuzhou, People's Republic of China
| | - Tong-Xia Li
- Department of Tuberculosis, Qingdao Chest Hospital, Qingdao, People's Republic of China
| | - Cui Cai
- Department of Tuberculosis, Guiyang Public Health Clinical Center, Guiyang, People's Republic of China
| | - Yun Zhou
- Department of Tuberculosis, The Second Affiliated Hospital of Hainan Medical University, Haikou, People's Republic of China
| | - Ma Zhuo
- Department of Tuberculosis, The Fourth People's Hospital of QingHai Province, Xining, People's Republic of China
| | - Jian-Yun Wang
- Department of Tuberculosis, Lanzhou Pulmonary Hospital, Lanzhou, People's Republic of China
| | - Wen-Long Guan
- Department of Tuberculosis, Chest Hospital of Xinjiang Uyghur Autonomous Region of the PRC, Urumchi, People's Republic of China
| | - Lin Xu
- Department of Tuberculosis, The Fourth People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, People's Republic of China
| | - Ji-Chan Shi
- Department of Tuberculosis, Wenzhou Central Hospital, Wenzhou, People's Republic of China
| | - Wei Shu
- Clinical Center on TB, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, No 9, Beiguan Street, Tongzhou District, Beijing, 101149, People's Republic of China
| | - Li-Li Cheng
- Beijing Innovation Alliance of TB Diagnosis and Treatment, Beijing, People's Republic of China
| | - Fei Teng
- Beijing Innovation Alliance of TB Diagnosis and Treatment, Beijing, People's Republic of China
| | - Yu-Jia Ning
- Clinical Center on TB, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, No 9, Beiguan Street, Tongzhou District, Beijing, 101149, People's Republic of China
| | - Shi-Heng Xie
- Clinical Center on TB, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, No 9, Beiguan Street, Tongzhou District, Beijing, 101149, People's Republic of China
| | - Yu-Xian Sun
- Clinical Center on TB, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, No 9, Beiguan Street, Tongzhou District, Beijing, 101149, People's Republic of China
| | - Li-Jie Zhang
- Clinical Center on TB, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, No 9, Beiguan Street, Tongzhou District, Beijing, 101149, People's Republic of China
| | - Yu-Hong Liu
- Clinical Center on TB, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, No 9, Beiguan Street, Tongzhou District, Beijing, 101149, People's Republic of China.
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Bedaquiline: Current status and future perspectives. J Glob Antimicrob Resist 2021; 25:48-59. [PMID: 33684606 DOI: 10.1016/j.jgar.2021.02.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/28/2021] [Accepted: 02/17/2021] [Indexed: 12/21/2022] Open
Abstract
The development of drug-resistant tuberculosis (TB) is a major threat worldwide. Based on World Health Organization (WHO) reports, it is estimated that more than 500 000 new cases of drug-resistant TB occur annually. In addition, there are alarming reports of increasing multidrug-resistant TB (MDR-TB) and the emergence of extensively drug-resistant TB (XDR-TB) from different countries of the world. Therefore, new options for TB therapy are required. Bedaquiline (BDQ), a novel anti-TB drug, has significant minimum inhibitory concentrations (MICs) both against drug-susceptible and drug-resistant TB. Moreover, BDQ was recently approved for therapy of MDR-TB. The current narrative review summarises the available data on BDQ resistance, describes its antimicrobial properties, and provides new perspectives on clinical use of this novel anti-TB agent.
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Shi L, Gao J, Gao M, Deng P, Chen S, He M, Feng W, Yang X, Huang Y, He F, Hu Y, Lei L, Li X, Du J, Hu X, Liu Z, Tang P, Han J, Wang H, Han Y, Shu W, Sun Y, Pei Y, Liu Y. Interim Effectiveness and Safety Comparison of Bedaquiline-Containing Regimens for Treatment of Diabetic Versus Non-Diabetic MDR/XDR-TB Patients in China: A Multicenter Retrospective Cohort Study. Infect Dis Ther 2021; 10:457-470. [PMID: 33515206 PMCID: PMC7954881 DOI: 10.1007/s40121-021-00396-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/05/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Diabetes mellitus (DM), a common tuberculosis (TB) comorbidity, is associated with delayed bacillary clearance during anti-TB treatment and unfavorable outcomes. Bedaquiline (BDQ), when used as part of multidrug regimen for multidrug-resistant/extensively drug-resistant tuberculosis (MDR/XDR-TB), has been shown to be effective and safe although treatment outcome and risks for patients with MDR/XDR-TB and DM are unknown. A multicenter retrospective study was conducted to compared the safety and effectiveness of 24-week BDQ-containing anti-TB treatment for patients with MDR/XDR-TB with and without DM. METHODS The study of patients with MDR/XDR-TB with or without DM (enrolled February 2018-September 2019, 21 Chinese hospitals) was supervised by the New Drug Introduction and Protection Program (NDIP). Of 640 patients with MDR/XDR-TB receiving BDQ-containing anti-TB treatments, two propensity score-matched groups (107 DM/107 non-DM) were compared for cumulative culture conversion rate, time to culture conversion, adverse events, and corrected QT interval. RESULTS Body mass index was higher in patients with DM than patients without DM (23.29 ± 3.9 vs. 20.5 ± 3.6, P < 0.001); lung cavity prevalence (86.9% vs. 72.9%, P = 0.037) was also higher in patients with DM; the non-DM group had higher hepatitis prevalence (29.0% vs. 15.9%, P = 0.022). No significant intergroup differences were found for sputum culture conversion rate at week 8 (80.0% vs. 81.4%, P = 0.884), at week 24 (95.6% vs. 98.2%, P = 0.629), or for median time to sputum culture conversion [56 days (IQR 28-63) vs. 56 days (IQR 28-84) (P = 0.687)]. Favorable post-24-week treatment outcomes were presented by 90.7% and 93.5% in the DM group and non-DM group, respectively, without significant intergroup differences (P = 0.448). The DM adverse event rate exceeded non-DM rate (77.6% vs. 64.5%, P = 0.035). CONCLUSION Despite some differences in baseline characteristics, Chinese patients with MDR/XDR-TB with or without DM had similar sputum culture conversion rates and favorable treatment outcomes post-24-week BDQ-containing anti-TB treatment. Low BMI but not DM is risk factor associated with unfavorable outcome of patients with MDR/XDR-TB.
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Affiliation(s)
- Li Shi
- Department of Tuberculosis, Changsha Central Hospital, University of South China, Changsha, 410007, China
| | - Jingtao Gao
- Clinical Center on TB, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, 101149, China
| | - Mengqiu Gao
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, 101149, China
| | - Ping Deng
- Department of Tuberculosis, Changsha Central Hospital, University of South China, Changsha, 410007, China
| | - Shu Chen
- Beijing Innovation Alliance of TB Diagnosis and Treatment, Beijing, 101149, China
| | - Minfu He
- Beijing Innovation Alliance of TB Diagnosis and Treatment, Beijing, 101149, China
| | - Wenjun Feng
- Department of Tuberculosis, Changsha Central Hospital, University of South China, Changsha, 410007, China
| | - Xiaoyun Yang
- Department of Tuberculosis, Changsha Central Hospital, University of South China, Changsha, 410007, China
| | - Yunhui Huang
- Department of Tuberculosis, Changsha Central Hospital, University of South China, Changsha, 410007, China
| | - Fang He
- Department of Tuberculosis, Changsha Central Hospital, University of South China, Changsha, 410007, China
| | - Yumeng Hu
- Department of Tuberculosis, Changsha Central Hospital, University of South China, Changsha, 410007, China
| | - Liping Lei
- Department of Tuberculosis, Changsha Central Hospital, University of South China, Changsha, 410007, China
| | - Xuelian Li
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, 101149, China
| | - Juan Du
- Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan, 430030, China
| | - Xiaomeng Hu
- Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan, 430030, China
| | - Zhi Liu
- Department of Tuberculosis, Shenzhen Third People's Hospital, Shenzhen, 518000, China
| | - Peijun Tang
- The Fifth People's Hospital of Suzhou, Suzhou, 215000, China
| | - Junfeng Han
- Tianjin Haihe Hospital, Tianjin, 300000, China
| | - Hua Wang
- Anhui Chest Hospital, Hefei, 230000, China
| | - Yi Han
- Anhui Chest Hospital, Hefei, 230000, China
| | - Wei Shu
- Clinical Center on TB, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, 101149, China
| | - Yuxian Sun
- Clinical Center on TB, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, 101149, China
| | - Yi Pei
- Department of Tuberculosis, Changsha Central Hospital, University of South China, Changsha, 410007, China.
| | - Yuhong Liu
- Clinical Center on TB, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, 101149, China.
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9
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Sachdeva KS, Parmar M, Patel Y, Gupta R, Rathod S, Chauhan S, Anand S, Ramachandran R. Evolutionary journey of programmatic services and treatment outcomes among drug resistant tuberculosis (DR-TB) patients under National TB Elimination Programme in India (2005-2020). Expert Rev Respir Med 2021; 15:885-898. [PMID: 33307889 DOI: 10.1080/17476348.2021.1850277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: India, with one-fourth of global burden of tuberculosis as well as multidrug-resistant TB, made bold commitment to end TB by 2025. There is no documented comprehensive review of the evolutionary journey of India's DRTB service expansion and changes in the treatment outcome so far.Area Covered: The current document presents evolution and journey of programmatic services and the progress in treatment outcomes among DRTB patients since 2005 with efforts cum challenges in nationwide scale-up of evidence-based policies and services, opportunities and future prospects for universalizing quality care - an essential ingredient to end TB in India. In the era of standardized longer treatment regimen till 2017, only half of the patients were successfully treated. Interventions to address factors associated with access and quality of care introduced since 2018 like universal drug susceptibility testing (UDST) guided treatment with shorter regimen, newer drugs, social protection; accelerated detection and began enhancing survival and success rate in recent DR-TB patient cohorts.Expert Opinion: Patient-centric care; robust TB/DR-TB surveillance system, shorter effective safer regimens and innovations, a milestone essential to end TB in India by 2025 to accomplish the vision of the Prime Minister of India.
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Affiliation(s)
| | - Malik Parmar
- National Professional Officer (Drug Resistant & Latent TB), WHO Country Office, New Delhi India
| | - Yogesh Patel
- National Consultant (DR-TB), WHO NTEP Technical Support Network, New Delhi, India
| | - Ritu Gupta
- Additional DDG - TB, Central TB Division, New Delhi, India
| | - Sandeep Rathod
- National Consultant (DR-TB), WHO NTEP Technical Support Network, New Delhi, India
| | - Sandeep Chauhan
- National Consultant (DR-TB), WHO NTEP Technical Support Network, New Delhi, India
| | - Sridhar Anand
- National Consultant (TB Laboratories), WHO NTEP Technical Support Network, New Delhi, India
| | - Ranjani Ramachandran
- National Professional Officer (TB & Laboratories), WHO Country Office, New Delhi, India
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10
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Martín-García M, Esteban J. Evaluating bedaquiline as a treatment option for multidrug-resistant tuberculosis. Expert Opin Pharmacother 2021; 22:535-541. [PMID: 33393406 DOI: 10.1080/14656566.2020.1867538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Despite efforts to the contrary, tuberculosis remains one of the leading causes of death in the world. The appearance of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains of Mycobacterium tuberculosis has increased the need for new therapeutic options against these strains.Areas covered: This review covers the in vitro susceptibility, pharmacokinetics, and pharmacodynamics of bedaquiline, a new drug shown to be active against M. tuberculosis-resistant strains. The authors further review clinical data concerning its use against MDR and XDR strains, discussing recent clinical guidelines from different international societies.Expert opinion: Available data demonstrate the usefulness of bedaquiline against resistant M. tuberculosis. Despite the difficulty in analyzing multidrug therapies, the use of bedaquiline in MDR and XDR tuberculosis increases success rates, allowing shortened treatments and lower drug use than previously recommended regimens. Moreover, the fact that MDR and XDR strains are common in many places creates a need to include this drug in the currently available protocols. It is essential to overcome the substantial barriers that some countries encounter in obtaining bedaquiline, as doing so will make therapeutic regimens including this drug available for all patients.
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Affiliation(s)
- Marta Martín-García
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
| | - Jaime Esteban
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
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11
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Sachdeva KS, Parmar M, Rao R, Chauhan S, Shah V, Pirabu R, Balasubramaniam D, Vadera B, Anand S, Mathew M, Solanki H, Sundar VV. Paradigm shift in efforts to end TB by 2025. Indian J Tuberc 2020; 67:S48-S60. [PMID: 33308672 DOI: 10.1016/j.ijtb.2020.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 11/16/2022]
Abstract
TB is a deadly infectious disease, in existence since time immemorial. This article traces the journey of TB developments in the last few decades and the path breaking moments that have accelerated the efforts towards Ending TB from National Tuberculosis Control Program (NTCP 1962-1992) to Revised National Tuberculosis Control Program (RNTCP - 1992-2019) and to National Tuberculosis Elimination Program (NTEP) as per the vision of Honorable Prime Minister of India. From increased funding for TB, the discovery of newer drugs and diagnostics, increased access to health facilities, greater investment in research and expanded reach of public health education, seasoned with TB activism and media's proactive role, private sector participation to political advocacy and community engagement, coupled with vaccine trials has renewed the hope of finding the elusive and miraculous breakthrough to END TB and it seems the goal is within the realms of the possibility. The recent paradigm shift in the policy and the drive of several states & UTs to move towards TB free status through rigorous population-based vulnerability mapping and screening coupled with active case finding is expected to act as the driving force to lead the country towards Ending TB by 2025. Continued investments in research, innovations and availability of more effective drugs and the vaccines will add to existing armamentarium towards Ending TB.
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Affiliation(s)
- K S Sachdeva
- Central TB Division, Ministry of Health & Family Welfare, Government of India, New Delhi, India.
| | | | - Raghuram Rao
- Central TB Division, Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | | | | | - Ra Pirabu
- WHO Country Office for India, New Delhi, India
| | | | - Bhavin Vadera
- Wadhwani Institute of Artificial Intelligence, India
| | - S Anand
- WHO Country Office for India, New Delhi, India
| | - Manu Mathew
- WHO Country Office for India, New Delhi, India
| | | | - V V Sundar
- WHO Country Office for India, New Delhi, India
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