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All-oral longer regimens are effective for the management of multidrug resistant tuberculosis in high burden settings | Journal Article / Research | MSF Science Portal
Journal Article
|Research

All-oral longer regimens are effective for the management of multidrug resistant tuberculosis in high burden settings

Khan PY, Franke MF, Hewison CCH, Seung KJ, Huerga H, Atwood S, Ahmed SM, Khan MA, Sultana T, Manzur-ul-Alam M, Vo LNQ, Lecca L, Yae K, Kozhabekov S, Tamirat M, Gelin A, Vilbrun SC, Kikvidze M, Faqirzai J, Kadyrov A, Skrahina A, Mesic A, Avagyan N, Bastard M, Rich ML, Khan UT, Mitnick CD

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Abstract
BACKGROUND
Recent World Health Organisation guidance on drug-resistant tuberculosis treatment de-prioritised injectable agents, in use for decades, and endorsed all-oral longer regimens. However, questions remain about the role of the injectable agent, particularly in the context of regimens using new and repurposed drugs. We compared the effectiveness of an injectable-containing regimen to that of an all-oral regimen among patients with drug-resistant tuberculosis who received bedaquiline- and/or delamanid as part of their multidrug regimen.

METHODS
Patients with a positive baseline culture were included. Six-month culture conversion was defined as two consecutive negative cultures collected >15 days apart. We derived predicted probabilities of culture conversion and relative risk using marginal standardisation methods.

RESULTS
Culture conversion was observed in 83.8% (526/628) of patients receiving an all-oral regimen and 85.5% (425/497) of those receiving an injectable-containing regimen. The adjusted relative risk comparing injectable-containing regimens to all-oral regimens was 0.96 (95%CI: 0.88–1.04). We found very weak evidence of effect modification by HIV status: among patients living with HIV, there was a small increase in the frequency of conversion among those receiving an injectable-containing regimen, relative to an all-oral regimen, which was not apparent in HIV-negative patients.

CONCLUSIONS
Among individuals receiving bedaquiline and/or delamanid as part of a multidrug regimen for drug-resistant tuberculosis, there was no significant difference between those who received an injectable and those who did not regarding culture conversion within 6 months. The potential contribution of injectable agents in the treatment of drug-resistant tuberculosis among those who were HIV positive requires further study.

Subject Area

tuberculosisantimicrobial resistance

Collections

The endTB project

Languages

English
DOI
10.1183/13993003.04345-2020
Published Date
17 Jun 2021
PubMed ID
34140298
Journal
European Respiratory Journal
Volume | Issue | Pages
Online ahead of print, Pages 2004345
Issue Date
2021-06-17
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