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Journal Article > Research

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

Bonnet MMB, Bastard M, du Cros PAK, Khamraev AK, Kimenye K, Khurkhumal S, Hayrapetyan A, Themba D, Telnov A, Sanchez-Padilla E, Hewison CCH, Varaine FFV
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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/m2, 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.
Countries
ArmeniaGeorgiaKenyaUzbekistan
Subject Area
antibiotic resistancetuberculosisantimicrobial resistance
DOI
10.5588/ijtld.15.0962
Published Date
01-Feb-2016
PubMed ID
26792469
Languages
English
Journal
International Journal of Tuberculosis and Lung Disease
Volume / Issue / Pages
Volume 20, Issue 2, Pages 177-186
Issue Date
01-Feb-2016
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