All-oral longer regimens are effective for the management of multidrug-resistant tuberculosis in high-burden settings
Khan P.Y. Franke M.F. Hewison C. Seung K.J. Huerga H. Atwood S. Ahmed S. Khan M. Sultana T. Manzur-Ul-Alam M. Vo L.N.Q. Lecca L. Yae K. Kozhabekov S. Tamirat M. Gelin A. Vilbrun S.C. Kikvidze M. Faqirzai J. Kadyrov A. Skrahina A. Mesic A. Avagyan N. Bastard M. Rich M.L. Khan U. Mitnick C.D.
1 January 2022European Respiratory Society
European Respiratory Journal
2022#59Issue 1
Background Recent World Health Organization guidance on drug-resistant tuberculosis treatment de-prioritised injectable agents, in use for decades, and endorsed all-oral longer regimens. However, questions remain about the role of the injectable agent, particularly in the context of regimens using new and repurposed drugs. We compared the effectiveness of an injectable-containing regimen to that of an alloral regimen among patients with drug-resistant tuberculosis who received bedaquiline and/or delamanid as part of their multidrug regimen. Methods Patients with a positive baseline culture were included. 6-month culture conversion was defined as two consecutive negative cultures collected <15 days apart. We derived predicted probabilities of culture conversion and relative risk using marginal standardisation methods. Results Culture conversion was observed in 83.8% (526 out of 628) of patients receiving an all-oral regimen and 85.5% (425 out of 497) of those receiving an injectable-containing regimen. The adjusted relative risk comparing injectable-containing regimens to all-oral regimens was 0.96 (95% CI 0.88-1.04). We found very weak evidence of effect modification by HIV status: Among patients living with HIV, there was a small increase in the frequency of conversion among those receiving an injectable-containing regimen, relative to an all-oral regimen, which was not apparent in HIV-negative patients. Conclusions Among individuals receiving bedaquiline and/or delamanid as part of a multidrug regimen for drug-resistant tuberculosis, there was no significant difference between those who received an injectable and those who did not regarding culture conversion within 6 months. The potential contribution of injectable agents in the treatment of drug-resistant tuberculosis among those who were HIV positive requires further study.
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Interactive Research and Development Global, Singapore, Singapore
Clinical Research Dept, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
Partners In Health, Boston, MA, United States
Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
Medical Dept, Médecins Sans Frontières, Paris, France
Division of Global Health Equity, Brigham and Womens Hospital, Boston, MA, United States
Field Epidemiology Dept, Epicentre, Paris, France
Interactive Research and Development, Karachi, Pakistan
Interactive Research and Development, Durban, South Africa
Interactive Research and Development, Dhaka, Bangladesh
Friends for International TB Relief, Ho Chi Minh City, Viet Nam
Socios En Salud Sucursal Peru, Lima, Peru
Partners In Health, Addis Ababa, Ethiopia, Ethiopia
Partners In Health, Almaty, Kazakhstan
Partners In Health, Maseru, Lesotho, Lesotho
Zanmi Lasante, Port-au-Prince, Haiti
Haitian Group for the Study of Kaposis Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
Médecins Sans Frontières, Georgia
Médecins Sans Frontières, Armenia
Médecins Sans Frontières, Kyrgyzstan
Médecins Sans Frontières, Belarus
Médecins Sans Frontières, Amsterdam, Netherlands
Interactive Research and Development Global
Clinical Research Dept
Partners In Health
Dept of Global Health and Social Medicine
Medical Dept
Division of Global Health Equity
Field Epidemiology Dept
Interactive Research and Development
Interactive Research and Development
Interactive Research and Development
Friends for International TB Relief
Socios En Salud Sucursal Peru
Partners In Health
Partners In Health
Partners In Health
Zanmi Lasante
Haitian Group for the Study of Kaposis Sarcoma and Opportunistic Infections (GHESKIO)
Médecins Sans Frontières
Médecins Sans Frontières
Médecins Sans Frontières
Médecins Sans Frontières
Médecins Sans Frontières
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