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    Mar 02, 2021
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    Culture Conversion in Patients Treated with Bedaquiline and/or Delamanid: A Prospective Multi-country Study.

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    Authors
    Franke, MF
    Khan, P
    Hewison, C
    Khan, U
    Huerga, H
    Seung, KJ
    Rich, ML
    Zarli, K
    Samieva, N
    Oyewusi, L
    Nair, P
    Mudassar, M
    Melikyan, N
    Lenggogeni, P
    Lecca, L
    Kumsa, A
    Khan, M
    Islam, S
    Hussein, K
    Docteur, W
    Chumburidze, N
    Berikova, E
    Atshemyan, H
    Atwood, S
    Alam, M
    Ahmed, S
    Bastard, M
    Mitnick, CD
    endTB observational study team
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    Issue Date
    2020-07-24
    Submitted date
    2020-10-06
    
    Metadata
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    Journal
    American Journal of Respiratory and Critical Care Medicine
    Abstract
    Background Bedaquiline and delamanid offer the possibility of more effective and less toxic multidrug-resistant tuberculosis (MDR-TB) treatment. With this treatment, however, some patients, remain at high risk for an unfavorable treatment outcome. The endTB observational study is the largest multicountry cohort of patients with rifampin-resistant/MDR-TB treated in routine care, according to WHO guidance, with delamanid- and/or bedaquiline-containing regimens. We report frequency of sputum culture conversion within six-months of treatment initiation and risk factors for non-conversion. Methods We included patients with a positive baseline culture who initiated a first endTB regimen prior to April 2018. Two consecutive negative cultures collected > 15 days apart constituted culture conversion. We used generalized mixed models to derive marginal predictions for the probability of culture conversion in key subgroups. Findings 1,109 patients initiated a multidrug treatment containing bedaquiline (63%), delamanid (27%) or both (10%). Of these, 939 (85%) experienced culture conversion within six months. In adjusted analyses, patients with HIV had a lower probability of conversion (0·73 [95% CI: 0·62, 0·84]) than patients without HIV (0·84 [95% CI: 0·79, 0·90]; p=0·03). Patients with both cavitary disease and highly positive sputum smear had a lower probability of conversion (0·68 [95% CI: 0·57, 0·79]) relative to patients without either (0·89; 95% CI: 0·84, 0·95; p=0·0004). Hepatitis C infection, diabetes mellitus/glucose intolerance, and baseline resistance were not associated with conversion. Interpretation Frequent sputum conversion in patients with rifampin-resistant/MDR-TB who were treated with bedaquiline and/or delamanid underscores the need for urgent expanded access to these drugs. There is a need to optimize treatment for patients with HIV and extensive disease.
    Publisher
    ATS Journals
    URI
    http://hdl.handle.net/10144/619743
    DOI
    10.1164/rccm.202001-0135OC
    PubMed ID
    32706644
    Type
    Article
    Language
    en
    Description
    We regret that this article is behind a paywall.
    EISSN
    1535-4970
    ae974a485f413a2113503eed53cd6c53
    10.1164/rccm.202001-0135OC
    Scopus Count
    Collections
    TB

    entitlement

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