Oelofse, S;
Esmail, A;
Diacon, AH;
Conradie, F;
Olayanju, O;
Ngubane, N;
Howell, P;
... Dheda, K; + view all
(2021)
Pretomanid with bedaquiline and linezolid for drug-resistant TB: a comparison of prospective cohorts.
The International Journal of Tuberculosis and Lung Disease
, 25
(6)
pp. 453-460.
10.5588/ijtld.21.0035.
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Abstract
BACKGROUND: There are no data comparing the 6-9 month oral three-drug Nix regimen (bedaquiline, pretomanid and linezolid [BPaL]) to conventional regimens containing bedaquiline (B, BDQ) and linezolid (L, LZD).METHODS: Six-month post end-of-treatment outcomes were compared between Nix-TB (n = 109) and 102 prospectively recruited extensively drug-resistant TB patients who received an ˜18-month BDQ-based regimen (median of 8 drugs). A subset of patients received BDQ and LZD (n = 86), and a subgroup of these (n = 75) served as individually matched controls in a pairwise comparison to determine differences in regimen efficacy.RESULTS: Favourable outcomes (%) were significantly better with BPaL than with the B-L-based combination regimen (98/109, 89.9% vs. 56/86, 65.1%; adjusted relative risk ratio [aRRR] 1.35; P < 0.001) and in the matched pairwise analysis (67/75, 89.3% vs. 48/75, 64.0%; aRRR 1.39; P = 0.001), despite significantly higher baseline bacterial load and prior second-line drug exposure in the BPaL cohort. Time to culture conversion (P < 0.001), time to unfavourable outcome (P < 0.01) and time to death (P < 0.03) were significantly better or lower with BPaL than the B-L-based combinations.CONCLUSION: The BPaL regimen (and hence substitution of multiple other drugs by pretomanid and/or higher starting-dose LZD) may improve outcomes in drug-resistant TB patients with poor prognostic features. However, prospective controlled studies are required to definitively answer this question.
| Type: | Article |
|---|---|
| Title: | Pretomanid with bedaquiline and linezolid for drug-resistant TB: a comparison of prospective cohorts |
| Location: | France |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.5588/ijtld.21.0035 |
| Publisher version: | http://dx.doi.org/10.5588/ijtld.21.0035 |
| Language: | English |
| Additional information: | This article is Open Access under the terms of the Creative Commons CC BY licence. (https://creativecommons.org/licenses/by/4.0/) |
| Keywords: | BPaL; bedaquiline; drug resistance; drug treatment; linezolid; tuberculosis |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10129013 |
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