In:
European Respiratory Journal, European Respiratory Society (ERS), Vol. 51, No. 5 ( 2018-05), p. 1800544-
Abstract:
Optimal treatment regimens for patients with extensively drug-resistant tuberculosis (XDR-TB) remain unclear. Long-term prospective outcome data comparing XDR-TB regimens with and without bedaquiline from an endemic setting are lacking. We prospectively followed-up 272 South African patients (49.3% HIV-infected; median CD4 count 169 cells·µL −1 ) with newly diagnosed XDR-TB between 2008 and 2017. Outcomes were compared between those who had not received bedaquiline (pre-2013; n=204) and those who had (post-2013; n=68; 80.9% received linezolid in addition). The 24-month favourable outcome rate was substantially better in the bedaquiline versus the non-bedaquiline group (66.2% (45 out of 68) versus 13.2% (27 out of 204); p 〈 0.001). In addition, the bedaquiline group exhibited reduced 24-month rates of treatment failure (5.9% versus 26.0%; p 〈 0.001) and default (1.5% versus 15.2%; p 〈 0.001). However, linezolid was withdrawn in 32.7% (18 out of 55) of patients in the bedaquiline group because of adverse events. Admission weight 〉 50 kg, an increasing number of anti-TB drugs and bedaquiline were independent predictors of survival (the bedaquiline survival effect remained significant in HIV-infected persons, irrespective of CD4 count). XDR-TB patients receiving a backbone of bedaquiline and linezolid had substantially better favourable outcomes compared to those not using these drugs. These data inform the selection of XDR-TB treatment regimens and roll-out of newer drugs in TB-endemic countries.
Type of Medium:
Online Resource
ISSN:
0903-1936
,
1399-3003
DOI:
10.1183/13993003.00544-2018
DOI:
10.1183/13993003.00544-2018.Supp1
Language:
English
Publisher:
European Respiratory Society (ERS)
Publication Date:
2018
detail.hit.zdb_id:
2834928-3
detail.hit.zdb_id:
1499101-9
Permalink