Identification of patients who could benefit from bedaquiline or delamanid: a multisite MDR-TB cohort study
2015; International Union Against Tuberculosis and Lung Disease; Volume: 20; Issue: 2 Linguagem: Inglês
10.5588/ijtld.15.0962
ISSN1815-8439
AutoresM. Bonnet, Mathieu Bastard, Philipp du Cros, Atadjan Khamraev, Kamene Kimenye, Shazina Khurkhumal, Արմեն Հայրապետյան, D Themba, Alex Telnov, Elisabeth Sánchez-Padilla, Catherine Hewison, Francis Varaine,
Tópico(s)Pneumocystis jirovecii pneumonia detection and treatment
ResumoThe 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.To identify patients at risk of unfavourable outcomes who may benefit from the new drugs.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.Of 1433 patients, 48.5% had body mass index (BMI) <18.5 kg/m(2), 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).In our cohort, patients who may benefit from bedaquiline and delamanid represented up to two thirds of all MDR-TB patients.
Referência(s)