Bedaquiline and Delamanid Effective in Multidrug-Resistant Tuberculosis

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More than 70% of patients achieved sputum culture conversion with bedaquiline and/or delamanid treatment.
More than 70% of patients achieved sputum culture conversion with bedaquiline and/or delamanid treatment.

Bedaquiline and delamanid were effective and safe for the treatment of multidrug-resistant tuberculosis (MDR-TB), according to the results of a study published in the European Respiratory Journal.

MDR-TB has become an important global health problem. Treatment may involve the administration of multiple drugs during a long period of time, which may result in low treatment success rates and an increased risk for adverse reactions.  

Researchers from South Korea evaluated 61 patients with MDR-TB treated with bedaquiline (n=39), delamanid (n=11), or both, either sequentially (n=10) or in coadministration (n=1) for more than a month, combined with a World Health Organization-recommended regimen.

Most of the patients (80.3%) were male and the median age was 53 years. In 68.9% of patients, fluoroquinolone-resistant MDR-TB was found and 26.2% had extensively drug-resistant TB. The median duration of treatment with bedaquiline and/or delamanid was 168 days, with 33 (54.1%) receiving linezolid for a median of 673 days. 

Of the 55 patients with a positive sputum culture at the start of bedaquiline and/or delamanid treatment, 39 (70.9%) achieved sputum culture conversion within a median of 119 days. Prolonged Fridericia corrected QT interval developed in 4 patients (6.6%), which forced their therapy to be halted.

The study had several limitations, mainly its retrospective design. Treatment decisions were made by attending physicians, and as a result, patients had different treatment regimens. In addition, selection bias may have occurred in enrolled patients. The small numbers of patients treated with delamanid prohibited a comparison of safety and efficacy with bedaquiline.

The authors concluded that although both drugs, either in combination or in sequential use, were effective and well tolerated, patients treated with bedaquiline and delamanid should be carefully monitored for Fridericia corrected QT interval prolongation.

Reference

Kim CT, Kim T-O, Shin H-J, et al. Bedaquiline and delamanid for the treatment of multidrug-resistant tuberculosis: a multicentre cohort study in Korea [published online March 15, 2018]. Eur Respir J. doi:10.1183/13993003.02467-2017

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