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Home / The International Journal of Tuberculosis and Lung Disease, Volume 20, Number 2

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

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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.

Keywords: drug resistance; outcomes; regimens; resource-limited; treatment; tuberculosis

Document Type: Research Article

Affiliations: 1: *Epicentre, Paris, France, †Institut de Recherche pour le Développement UMI 233 TransVIHMI - UM – INSERM U117, Montpellier, France 2: *Epicentre, Paris, France 3: ‡Médecins Sans Frontières (MSF), London, UK 4: §Ministry of Health of Karakalpakstan, Nukus, Uzbekistan 5: Division of Leprosy Tuberculosis and Lung Disease, Nairobi, Kenya 6: #Abkhazian National Tuberculosis Programme, Sukhumi, Abkhazia 7: **Armenian National Tuberculosis Programme, Yerevan, Armenia 8: ††Ministry of Health of Swaziland, Mbabane, Swaziland 9: ‡‡MSF, Geneva, Switzerland 10: §§MSF, Paris, France

Publication date: 01 February 2016

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