Long-term outcome and safety of prolonged bedaquiline treatment for multidrug-resistant tuberculosis

[摘要] Bedaquiline; a recently approved drug for the treatment of multidrug-resistant tuberculosis (MDR-TB); is recommended for a duration of 24xe2x80x85weeks. There are scarce data on patients treated with this drug outside clinical trials.All MDR-TB patients who started treatment from January 1; 2011 to December 31; 2013 and received xe2x89xa530xe2x80x85days of bedaquiline were included in a multicentre observational cohort.Among 45 MDR-TB patients; 53% harboured isolates resistant to both fluoroquinolones and second-line injectables; and 38% harboured isolates resistant to one of these drug classes. Median bedaquiline treatment duration was 361xe2x80x85days and 33 patients (73%) received prolonged (>190xe2x80x85days) bedaquiline treatment. Overall; 36 patients (80%) had favourable outcome; five were lost to follow-up; three died; and one failed and acquired bedaquiline resistance. No cases of recurrence were reported. Severe and serious adverse events were recorded in 60% and 18% of patients; respectively. Values of Fridericia-corrected QT interval (QTcF) >500xe2x80x85ms were recorded in 11% of patients; but neither arrhythmias nor symptomatic cardiac side-effects occurred. Bedaquiline was discontinued in three patients following QTcF prolongation. No significant differences in outcomes or adverse events rates were observed between patients receiving standard and prolonged bedaquiline treatment.Bedaquiline-containing regimens achieved favourable outcomes in a large proportion of patients. Prolonged bedaquiline treatment was overall well tolerated in this cohort.

[学科分类] 呼吸医学