Bedaquiline, Delamanid, Linezolid and Clofazimine for Treatment of Pre-extensively Drug-Resistant Tuberculosis.

Padmapriyadarsini, Chandrasekaran and Vohra, Vikram and Bhatnagar, Anuj and Solanki, Rajesh and Sridhar, Rathinam and Anande, Lalitkumar and Muthuvijaylakshmi, M and Bhatia, Miraa and Jeyadeepa, Bharathi and Taneja, Gaurav and Balaji, S and Shah, Prashant and Saravanan, N and Chauhan, Vijay and Kumar, Hemanth and Ponnuraja, Chinnayin and Livchits, Viktoriya and Bahl, Monica and Alavadi, Umesh and Sachdeva, K S and Swaminathan, Soumya (2022) Bedaquiline, Delamanid, Linezolid and Clofazimine for Treatment of Pre-extensively Drug-Resistant Tuberculosis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 76 (3). e938-46. ISSN 1537-6591

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Abstract

BACKGROUND Treatment success rates for multidrug-resistant tuberculosis (MDR-TB) remain low globally. Availability of newer drugs has given scope to develop regimens that can be patient-friendly, less toxic, with improved outcomes. We proposed to determine the effectiveness of an entirely oral, short-course regimen with Bedaquiline and Delamanid in treating MDR-TB with additional resistance to fluoroquinolones (MDR-TBFQ+) or second-line injectable (MDR-TBSLI+). METHODS We prospectively determined the effectiveness and safety of combining two new drugs with two repurposed drugs - Bedaquiline, Delamanid, Linezolid, and Clofazimine for 24-36 weeks in adults with pulmonary MDR-TBFQ+ or/and MDR-TBSLI+. The primary outcome was a favorable response at end of treatment, defined as two consecutive negative cultures taken four weeks apart. The unfavorable outcomes included bacteriologic or clinical failure during treatment period. RESULTS Of the 165 participants enrolled, 158 had MDR-TBFQ+. At the end of treatment, after excluding 12 patients due to baseline drug susceptibility and culture negatives, 139 of 153 patients (91%) had a favorable outcome. Fourteen patients (9%) had unfavorable outcomes: four deaths, seven treatment changes, two bacteriological failures, and one withdrawal. During treatment, 85 patients (52%) developed myelosuppression, 69 (42%) reported peripheral neuropathy, and none had QTc(F) prolongation >500msec. At 48 weeks of follow-up, 131 patients showed sustained treatment success with the resolution of adverse events in the majority. CONCLUSION After 24-36 weeks of treatment, this regimen resulted in a satisfactory favorable outcome in pulmonary MDR-TB patients with additional drug resistance. Cardiotoxicity was minimal, and myelosuppression, while common, was detected early and treated successfully.

Affiliation:	ICMR-National Institute for Research in Tuberculosis
Item Type:	Article
Uncontrolled Keywords:	Delamanid; Drug-resistant Tuberculosis; Effectiveness; Linezolid; Short-course.
Subjects:	Tuberculosis > Clinical Research
Divisions:	Clinical Research
Depositing User:	Dr. Rathinasabapati R
Date Deposited:	29 Mar 2023 07:20
Last Modified:	29 Mar 2023 07:20
URI:	http://eprints.nirt.res.in/id/eprint/1895

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