Culture Conversion in Patients Treated with Bedaquiline and/or Delamanid. A Prospective Multicountry Study

Autor: Helena Huerga, Elmira A. Berikova, M.R. Khan, Lawrence Oyewusi, Kerow Hussein, Andargachew Kumsa, Molly F. Franke, Carole D. Mitnick, Michael Rich, Leonid Lecca, Manzurul Alam, Parvati Nair, Nino Chumburidze, Mishaz Mudassar, Nazgul Samieva, Khin Zarli, Wisny Docteur, Palwasha Khan, Saman Ahmed, Hakob Atshemyan, Sidney Atwood, Mathieu Bastard, Putri Lenggogeni, Cathy Hewison, S.S. Islam, Kwonjune J. Seung, Uzma Khan, Nara Melikyan
Rok vydání: 2020
Předmět:
Pulmonary and Respiratory Medicine
Adult
Male
medicine.medical_specialty
sputum conversion
Tuberculosis
Adolescent
Antitubercular Agents
Critical Care and Intensive Care Medicine
Cohort Studies
03 medical and health sciences
chemistry.chemical_compound
Young Adult
0302 clinical medicine
Bacterial Proteins
Internal medicine
Tuberculosis
Multidrug-Resistant
medicine
Culture conversion
extensively drug-resistant tuberculosis
Humans
In patient
030212 general & internal medicine
Prospective Studies
Diarylquinolines
rifampicin-resistant tuberculosis
Child
Oxazoles
Aged
Aged
80 and over
business.industry
Sputum
Extensively drug-resistant tuberculosis
Original Articles
Middle Aged
multidrug-resistant tuberculosis
medicine.disease
Treatment Outcome
030228 respiratory system
chemistry
Rifampicin resistant tuberculosis
Nitroimidazoles
interim outcome
Tuberculosis and Mycobacterial Disease
Female
Delamanid
Bedaquiline
business
medicine.drug
Zdroj: American Journal of Respiratory and Critical Care Medicine
ISSN: 1535-4970
1073-449X
Popis: We regret that this article is behind a paywall.
Background Bedaquiline and delamanid offer the possibility of more effective and less toxic multidrug-resistant tuberculosis (MDR-TB) treatment. With this treatment, however, some patients, remain at high risk for an unfavorable treatment outcome. The endTB observational study is the largest multicountry cohort of patients with rifampin-resistant/MDR-TB treated in routine care, according to WHO guidance, with delamanid- and/or bedaquiline-containing regimens. We report frequency of sputum culture conversion within six-months of treatment initiation and risk factors for non-conversion. Methods We included patients with a positive baseline culture who initiated a first endTB regimen prior to April 2018. Two consecutive negative cultures collected > 15 days apart constituted culture conversion. We used generalized mixed models to derive marginal predictions for the probability of culture conversion in key subgroups. Findings 1,109 patients initiated a multidrug treatment containing bedaquiline (63%), delamanid (27%) or both (10%). Of these, 939 (85%) experienced culture conversion within six months. In adjusted analyses, patients with HIV had a lower probability of conversion (0·73 [95% CI: 0·62, 0·84]) than patients without HIV (0·84 [95% CI: 0·79, 0·90]; p=0·03). Patients with both cavitary disease and highly positive sputum smear had a lower probability of conversion (0·68 [95% CI: 0·57, 0·79]) relative to patients without either (0·89; 95% CI: 0·84, 0·95; p=0·0004). Hepatitis C infection, diabetes mellitus/glucose intolerance, and baseline resistance were not associated with conversion. Interpretation Frequent sputum conversion in patients with rifampin-resistant/MDR-TB who were treated with bedaquiline and/or delamanid underscores the need for urgent expanded access to these drugs. There is a need to optimize treatment for patients with HIV and extensive disease.
Databáze: OpenAIRE
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