Prospects for the use of new generation of anti-tuberculosis drugs in treatment of drug-resistant tuberculosis (experimental and clinical study)

Павлова, М. В.; Васильевна, Павлова Мария; Vinogradova, Tatiana; Ивановна, Виноградова Татьяна; Заболотных, Н. В.; Вячеславовна, Заболотных Наталья; Ershova, Elena S.; Сергеевна, Ершова Елена; Сапожникова, Н. В.; Валентиновна, Сапожникова Надежда; Чернохаева, И. В.; Владиславовна, Чернохаева Ирина; Арчакова, Л. И.; Ивановна, Арчакова Людмила; Vitovskaya, Maria; Львовна, Витовская Мария; Dogonadze, Marine; Зауриевна, Догонадзе Марине; Старшинова, Анна; Андреевна, Старшинова Анна; Grishko, Alevtina N.; Николаевна, Гришко Алевтина; Yablonsky, Petr K.; Казимирович, Яблонский Петр

doi:10.17816/rcf16433-40

Cited by 4 publications

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“…Generalization of the experience gained in the country conditions over a long period of the time is an important point in identifying the advantages of therapy with the inclusion of bedaquiline, and identifying possible disadvantages [ 52 , 53 ]. In the future, identification of existing shortcomings will make it possible to avoid the formation of drug resistance of mycobacteria to new drugs [ 54 , 55 , 56 , 57 ], which will limit the possibilities of therapy and reduce its effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Tuberculosis Treatment in Patients with Drug-Resistant Tuberculosis with the Use of Bedaquiline: The Experience of the Russian Federation

Старшинова

Dovgalyk

Belyaeva³

et al. 2022

Antibiotics

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In the conditions of the continued growth of multiple- and extensive drug-resistant tuberculosis, use of the new highly effective anti-tuberculosis drugs in this patient category is of great relevance. The aim of the study was determination the efficacy of treatment in patients with multidrug- and extensive drug-resistant tuberculosis using bedaquiline based on studies published in the Russian Federation. Materials and methods: The authors analyzed data published in studies from 2014 to 2022; 41 publications were included in total and 17 articles corresponded to the study design. The results of treatment of 1404 tuberculosis patients with MDR/XDR TB were described. Bedaquiline was used according to the standard scheme with a description of the treatment results after 24–26 weeks. Treatment efficacy was estimated according to accepted criteria. Results of the study: The analysis showed that the treatment efficacy on conversion was achieved in 79.5% of cases (95% Cl 76.5–82.3), and recovery was observed in 82.0% of cases (95% Cl 78.6–85.1). Departure from the therapy was observed in rare cases (9.8%; 95% Cl 7.9–12.2). Deaths were recorded in 6.5% of cases (95% Cl 4.9–8.3), which were associated with the severe disease and concomitant pathology in 74.3%. The development of adverse events was noted in half of the patients (55.7%); however, bedaquiline cancellation occurred in a few cases (7.0%; 95% Cl 3.0–13.0). From analyzing data in patients with MDR and XDR TB, the efficacy of treatment was 89.9% (95% Cl 85.9–93.2) and 71.9% (95% Cl 66.2–77.1), respectively. Conclusion: Use of bedaquiline in treatment makes it possible to achieve recovery of patients with MDR/XDR TB in 82.0% of cases with patients dropping out of treatment in 9.8%. At the same time, in patients with MDR TB, recovery was achieved in 89.9% of cases, while in patients with XDR TB, 71.9% of cases recovered.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Tuberculosis Treatment in Patients with Drug-Resistant Tuberculosis with the Use of Bedaquiline: The Experience of the Russian Federation

Старшинова

Dovgalyk

Belyaeva³

et al. 2022

Antibiotics

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Bedaquiline in the complex treatment of HIV-associated respiratory tuberculosis

Мордык

Иванова

Sitnikova³

et al. 2022

Medicinskij sovet

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Introduction. The continued decline in the number of patients shedding multidrug-resistant mycobacteria (MDR MDR), which has continued since 2018, determines the priority of measures to improve the effectiveness of treatment of newly diagnosed patients, including HIV-associated tuberculosis, with the mandatory inclusion of new anti-tuberculosis drugs in the treatment regimens of patients. drugs.Aim. To evaluate the efficacy and safety of bedaquiline in the complex treatment of patients with HIV-associated respiratory tuberculosis.Materials and methods. In the prospective study was included 60 patients with newly diagnosed HIV-associated respiratory tuberculosis, randomized into 2 groups: group 1 – 30 patients who received bedaquiline in the combination of anti-tuberculosis drugs; group 2 – 30 patients who received therapy without the addition of bedaquiline. Bacterial excretion was detected in all patients of the 1st and 2nd groups, the MBT drug sensitivity test confirmed the presence of pre-XDR MBT. Patients in both study groups received antiretroviral therapy. The follow-up period for patients was 12 months.Results. In the group of patients treated with bedaquiline, higher treatment results were noted both in terms of the criterion “closing of decay cavities” (by 14.7%) (p > 0.05) and by the criterion “cessation of bacterial excretion” (by 23.3%) ((p <0.05).Conclusions. The high clinical efficacy and safety of the use of bedaquiline in the complex treatment of patients with HIV-associated respiratory tuberculosis has been demonstrated. The data obtained make it possible to recommend the use of bedaquiline in the treatment of patients with newly diagnosed HIV-associated tuberculosis, isolating MBT with pre-XDR, to increase the effectiveness of the main course of chemotherapy, prevent the amplification of MBT drug resistance and develop extensive MBT drug resistance.

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Bedaquiline practice in treatment of extensively drug-resistant mycobacterium tuberculosis in children: Clinical cases

Akzhigitova

Ignatova

Konratov

et al. 2022

Kuban. nauсh. med. vestnik

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Background. Bedaquiline is currently a drug of choice in therapy for extensively and multidrug-resistant tuberculosis. It is indicated for children from a 6-year age and young adults as part of a combination chemotherapy, in compliance with the medical council’s (MC) regulation on active extensively and multidrug-resistant tuberculosis.Clinical Cases Description. The article describes the clinical cases of bedaquiline treatment of extensively drug-resistant tuberculosis in сhildren. Patient B., 16 yo, was routinely admitted to a children’s ward of the Orenburg Regional Clinical Antituberculosis Dispensary with the preliminary diagnosis: exudative pleurisy-complicated S1,2 infiltrative focal tuberculosis of left lung. Mycobactérium tuberculósis (MBT) (-). Complaints of cough, painful chest at deep breath, 37.3°C-elevated body temperature. Chest X-ray: left focal shadows in S1,2, intensive homogeneous darkening due to pleural effusion from diaphragm to anterior segment of rib III. An urgent pleural puncture was performed to sample fluid for MBTculture and PCR resistance tests to streptomycin and rifampicin. The patient was treated with anti-tuberculosis drugs according to the IV chemotherapy regimen. Taking into account the MBTculture results, the Medical Board took the decision to start using the V chemotherapy regimen with the inclusion of up to 180 doses of bedaquiline. The patient received anti-TB drugs according to chemotherapy regimen IV. Based on the pleural fluid PCR tests, the MC prescribed a conversion to chemotherapy regimen V with adding bedaquiline up to 180 doses. After 7 months of positive dynamics, the patient was transferred to continuation phase at a children’s sanatorium. Patient S., 10 yo, was routinely admitted to a children’s ward of the Orenburg Regional Clinical Antituberculosis Dispensary with the diagnosis: two-sided bronchopulmonary intrathoracic lymph nodes tuberculosis (ILNTB), calcification phase, MBT (-), follow-up care level I. Given the child’s triple contact with tuberculosis carriers, including extensively drug-resistant (XDR) tuberculosis, the MC prescribed antibacterial drug chemotherapy IF regimen V with adding bedaquiline up to 180 doses: pyrazinamide (Z), prothionamide (Pto), para-aminosalicylic acid (PAS), cycloserine (Cs), bedaquiline (Bq) concurrently with vitamins and hepatoprotectors (ZPtoPASCsBq). After 4 months of positive dynamics, the patient was transferred to anti-bacterial therapy continuation phase 4 (ZPtoCsPAS) for up to 12 months at a children’s sanatorium.Conclusion. The clinical cases presented demonstrate the efficacy of bedaquiline in adolescents having extensively drug-resistant focal pulmonary tuberculosis and intrathoracic lymph nodes tuberculosis. The prescription of bedaquiline in this age cohort requires careful justification and a monitoring of adverse reactions and antituberculosis chemotherapy complications.

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Prospects for the use of new generation of anti-tuberculosis drugs in treatment of drug-resistant tuberculosis (experimental and clinical study)

Cited by 4 publications

References 1 publication

Efficacy of Tuberculosis Treatment in Patients with Drug-Resistant Tuberculosis with the Use of Bedaquiline: The Experience of the Russian Federation

Efficacy of Tuberculosis Treatment in Patients with Drug-Resistant Tuberculosis with the Use of Bedaquiline: The Experience of the Russian Federation

Bedaquiline in the complex treatment of HIV-associated respiratory tuberculosis

Bedaquiline practice in treatment of extensively drug-resistant mycobacterium tuberculosis in children: Clinical cases

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