Bedaquiline-based regimen improves outcomes in drug resistant tuberculosis, suggests study

A new study published in the Journal of Clinical Tuberculosis and Other Mycobacterial Diseases showed that two bedaquiline-containing regiments maintained effectiveness and safety beyond 132 weeks, marking a significant advancement in the treatment of RR-TB.

Roughly 25% of people on the planet are thought to have come into contact with TB bacterium. In the world, tuberculosis (TB) is the thirteenth leading cause of death. It is also the second leading infectious agent (after COVID-19) that causes death, more often than HIV and AIDS combined. Treatment regimens for multidrug-resistant tuberculosis (MDR-TB) are complex and costly, posing a serious threat to public health and raising concerns about health security. The unsatisfactory treatment results for MDR-TB are demonstrated by the about 50% success rate among patients undertaking therapy.

A relatively new medication called bedaquiline has shown promise in treating MDR-TB. The substance in issue is a unique therapeutic agent with a distinct mode of action when compared to currently known anti-tuberculosis treatments. Thus, the study by Obaid Ur Rehman and colleagues set out to evaluate the effectiveness and safety profile of bedaquiline-based therapy regimens by a meta-analysis and systematic review of the literature.

To locate pertinent material for this investigation, an electronic search was conducted on PubMed, ScienceDirect, and the Cochrane library starting in March 2021. A p-value of less than 0.05 indicated publication bias, and the pooled treatment success rate and 95% confidence intervals were evaluated using a random-effects model.

Database search yielded a total of 543 publications, of which 12 new research satisfied the inclusion requirements. There were 41 publications in all, which comprised 5 experimental and 36 observational studies, that were included in the review. In the observational research, the pooled treatment success rate was 76.9%, whereas in the experimental investigations, it was 81.7%. On the basis of treatment plans including bedaquiline alone and plans comprising both bedaquiline and delamanid, further subgroup analysis was carried out. In trials where patients received therapy with regimens including bedaquiline alone, the pooled treatment success rate was 78.4%. In studies where patients received treatment with regimens containing both bedaquiline and delamanid, it was 73.6%.

Overall, high rates of culture conversion and treatment effectiveness are seen in patients with drug-resistant TB who are receiving therapy with a bedaquiline-based regimen and have extremely resistant strains of Mycobacterium tuberculosis.

Source:

Ur Rehman, O., Fatima, E., Ali, A., Akram, U., Nashwan, A., & Yunus, F. (2024). Efficacy and safety of bedaquiline containing regimens in patients of drug-resistant tuberculosis: An updated systematic review and meta-analysis. In Journal of Clinical Tuberculosis and Other Mycobacterial Diseases (Vol. 34, p. 100405). Elsevier BV. https://doi.org/10.1016/j.jctube.2023.100405