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Open Access Identification of patients who could benefit from bedaquiline or delamanid: a multisite MDR-TB cohort study

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BACKGROUND: The World Health Organization recommends adding bedaquiline or delamanid to multidrug-resistant tuberculosis (MDR-TB) regimens for which four effective drugs are not available, and delamanid for patients at high risk of poor outcome.

OBJECTIVE: To identify patients at risk of unfavourable outcomes who may benefit from the new drugs.

METHODS: Retrospective cohort study of treatment outcomes involving four to five effective drugs for 15–24 months in programmes in Uzbekistan, Georgia, Armenia, Swaziland and Kenya between 2001 and 2011.

RESULTS: Of 1433 patients, 48.5% had body mass index (BMI) <18.5 kg/m2, 72.9% had a high bacillary load, 16.7% were resistant to two injectables, 2.9% were resistant to ofloxacin (OFX) and 3.0% had extensively drug-resistant TB (XDR-TB). Treatment success ranged from 59.7% (no second-line resistance) to 27.0% (XDR-TB). XDR-TB (aOR 8.16, 95%CI 3.22–20.64), resistance to two injectables (aOR 1.90, 95%CI 1.00–3.62) or OFX (aOR 5.56, 95%CI 2.15–14.37), past incarceration (aOR 1.88, 95%CI 1.11–3.2), history of second-line treatment (aOR 3.24, 95%CI 1.53–6.85), low BMI (aOR 2.22, 95%CI 1.56–3.12) and high bacillary load (aOR 2.32, 95%CI 1.15–4.67) were associated with unfavourable outcomes. Patients started on capreomycin rather than kanamycin were more likely to have an unfavourable outcome (aOR 1.54, 95%CI 1.04–2.28).

CONCLUSION: In our cohort, patients who may benefit from bedaquiline and delamanid represented up to two thirds of all MDR-TB patients.
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Keywords: drug resistance; outcomes; regimens; resource-limited; treatment; tuberculosis

Document Type: Research Article

Affiliations: 1: *Epicentre, Paris, France, Institut de Recherche pour le Développement UMI 233 TransVIHMI - UM – INSERM U117, Montpellier, France 2: *Epicentre, Paris, France 3: Médecins Sans Frontières (MSF), London, UK 4: §Ministry of Health of Karakalpakstan, Nukus, Uzbekistan 5: Division of Leprosy Tuberculosis and Lung Disease, Nairobi, Kenya 6: #Abkhazian National Tuberculosis Programme, Sukhumi, Abkhazia 7: **Armenian National Tuberculosis Programme, Yerevan, Armenia 8: ††Ministry of Health of Swaziland, Mbabane, Swaziland 9: ‡‡MSF, Geneva, Switzerland 10: §§MSF, Paris, France

Publication date: February 1, 2016

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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