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Impact of bedaquiline on treatment outcomes of multidrug-resistant tuberculosis in a high-burden country

Dumitru Chesov, Jan Heyckendorf, Sofia Alexandru, Ana Donica, Elena Chesov, Maja Reimann, Valeriu Crudu, Victor Botnaru, Christoph Lange
European Respiratory Journal 2021 57: 2002544; DOI: 10.1183/13993003.02544-2020
Dumitru Chesov
1Dept of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
2Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
3German Center for Infection Research (DZIF), Partner Site Hamburg–Lübeck–Borstel–Riems, Borstel, Germany
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  • For correspondence: dumitru.chesov@usmf.md
Jan Heyckendorf
2Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
3German Center for Infection Research (DZIF), Partner Site Hamburg–Lübeck–Borstel–Riems, Borstel, Germany
4Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany
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  • ORCID record for Jan Heyckendorf
Sofia Alexandru
5National TB Reference Laboratory, Chiril Draganiuc Phthisiopneumology Institute, Chisinau, Republic of Moldova
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Ana Donica
5National TB Reference Laboratory, Chiril Draganiuc Phthisiopneumology Institute, Chisinau, Republic of Moldova
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Elena Chesov
1Dept of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
2Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
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Maja Reimann
2Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
3German Center for Infection Research (DZIF), Partner Site Hamburg–Lübeck–Borstel–Riems, Borstel, Germany
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Valeriu Crudu
5National TB Reference Laboratory, Chiril Draganiuc Phthisiopneumology Institute, Chisinau, Republic of Moldova
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Victor Botnaru
1Dept of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
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Christoph Lange
2Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
3German Center for Infection Research (DZIF), Partner Site Hamburg–Lübeck–Borstel–Riems, Borstel, Germany
4Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany
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Abstract

Background Evaluation of novel anti-tuberculosis (TB) drugs for the treatment of multidrug-resistant (MDR)-TB continues to be of high interest on the TB research agenda. We assessed treatment outcomes in patients with pulmonary MDR-TB who received bedaquiline-containing treatment regimens in the Republic of Moldova, a high-burden MDR-TB country.

Method We systematically analysed the SIMETB national electronic TB database and performed a retrospective propensity score-matched comparison of treatment outcomes in a cohort of patients with MDR-TB who started treatment during 2016–2018 with a bedaquiline-containing regimen (bedaquiline cohort) and a cohort of patients treated without bedaquiline (non-bedaquiline cohort).

Results Following propensity score matching, 114 patients were assigned to each cohort of MDR-TB patients. Patients in the bedaquiline cohort had a higher 6-month sputum culture conversion rate than those in the non-bedaquiline cohort (66.7% versus 40.3%; p<0.001). Patients under bedaquiline-containing regimens had a higher cure rate assessed by both World Health Organization (WHO) and TBnet definitions (55.3% versus 24.6%; p=0.001 and 43.5% versus 19.6%; p=0.004, respectively), as well as a lower mortality rate (8.8% versus 20.2%; p<0.001 and 10.9% versus 25.2%; p=0.01, respectively). In patients who previously failed on MDR-TB treatment, >40% of patients achieved a cure with a bedaquiline-containing regimen.

Conclusions Bedaquiline-based MDR-TB treatment regimens result in better disease resolution when compared with bedaquiline-sparing MDR-TB treatment regimens under programmatic conditions in a country with a high burden of MDR-TB.

Abstract

Used under programmatic conditions in a high-burden MDR-TB setting, bedaquiline-based MDR-TB treatment regimens result in faster and more sustained disease resolution than bedaquiline-sparing MDR-TB treatment regimens https://bit.ly/37mSQOT

Footnotes

  • This article has an editorial commentary: https://doi.org/10.1183/13993003.00066-2021

  • Conflict of interest: D. Chesov has nothing to disclose.

  • Conflict of interest: J. Heyckendorf reports personal fees for lectures from Chiesi, Gilead, Janssen and Lucane, outside the submitted work.

  • Conflict of interest: S. Alexandru has nothing to disclose.

  • Conflict of interest: A. Donica has nothing to disclose.

  • Conflict of interest: E. Chesov has nothing to disclose.

  • Conflict of interest: M. Reimann has nothing to disclose.

  • Conflict of interest: V. Crudu has nothing to disclose.

  • Conflict of interest: V. Botnaru has nothing to disclose.

  • Conflict of interest: C. Lange reports personal fees for lectures from Chiesi, Gilead, Janssen, Lucane, Novartis, Oxoid, Berlin-Chemie and Thermo Fisher, personal fees for meeting attendance from Oxford Immunotec, outside the submitted work.

  • Received July 1, 2020.
  • Accepted November 23, 2020.
  • Copyright ©ERS 2021
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Impact of bedaquiline on treatment outcomes of multidrug-resistant tuberculosis in a high-burden country
Dumitru Chesov, Jan Heyckendorf, Sofia Alexandru, Ana Donica, Elena Chesov, Maja Reimann, Valeriu Crudu, Victor Botnaru, Christoph Lange
European Respiratory Journal Jun 2021, 57 (6) 2002544; DOI: 10.1183/13993003.02544-2020

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Impact of bedaquiline on treatment outcomes of multidrug-resistant tuberculosis in a high-burden country
Dumitru Chesov, Jan Heyckendorf, Sofia Alexandru, Ana Donica, Elena Chesov, Maja Reimann, Valeriu Crudu, Victor Botnaru, Christoph Lange
European Respiratory Journal Jun 2021, 57 (6) 2002544; DOI: 10.1183/13993003.02544-2020
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