Safety and Effectiveness Outcomes From a 14-Country Cohort of Patients With Multi-Drug Resistant Tuberculosis Treated Concomitantly With Bedaquiline, Delamanid, and Other Second-Line Drugs

Abstract

Background Concomitant use of bedaquiline (Bdq) and delamanid (Dlm) for multi-drug/rifampicin resistant tuberculosis (MDR/RR-TB) has raised concerns about a potentially poor risk-benefit ratio. Yet, this combination is an important alternative for patients infected with strains of TB with complex drug resistance profiles or who cannot tolerate other therapies. We assessed safety and treatment outcomes of MDR/RR-TB patients receiving concomitant Bdq and Dlm, along with other second-line anti-TB drugs. Methods We conducted a multi-centric, prospective observational cohort study across 14 countries among patients receiving concomitant Bdq-Dlm treatment. Patients were recruited between April 2015 and September 2018 and were followed until the end of treatment. All serious adverse events and adverse events of special interest (AESI), leading to a treatment change, or judged significant by a clinician, were systematically monitored and documented. Results Overall, 472 patients received Bdq and Dlm concomitantly. A large majority also received linezolid (89.6%) and clofazimine (84.5%). Nearly all (90.3%) had extensive disease; most (74.2%) had resistance to fluoroquinolones. The most common AESI were peripheral neuropathy (134, 28.4%) and electrolyte depletion (94, 19.9%). Acute kidney injury and myelosuppression were seen in 40 (8.5%) and 24 (5.1%) of patients, respectively. QT prolongation occurred in 7 (1.5%). Overall, 78.0% (358/458) had successful treatment outcomes, 8.9% died and 7.2% experienced treatment failure. Conclusions Concomitant use of Bdq and Dlm, along with linezolid and clofazimine, is safe and effective for MDR/RR-TB patients with extensive disease. Using these drugs concomitantly is a good therapeutic option for patients with resistance to many anti-TB drugs.

Six Months of Bedaquiline-Pretomanid-Linezolid (BPaL) Regimen in Patients with Drug-Resistant Tuberculosis: A Narrative Review

“…[20] A study by Huerga et al demonstrated that 358/458 patients (78.0%) had a favorable outcome in a regimen containing bedaquiline-delamanid. [21] Compared to the study by Phuong et al, reported in patients with RR-TB who received five drugs of STR (bedaquiline, levofloxacin, linezolid, clofazimine, and/or pyrazinamide), the successful treatment was 95/106 (90%). Meanwhile, unfavorable outcomes including treatment failure, death, and loss of follow-up were 4%, 1%, and 6%, respectively.…”

Mtb-Selective 5-Aminomethyl Oxazolidinone Prodrugs: Robust Potency and Potential Liabilities

“…The mixture was degassed and refilled with Ar gas several times. After stirring at 60 °C overnight, the mixture was purified to give the desired product 7 (76%) as a white solid: R f = 0.52 (MeOH: DCM, 1.0:9.0, v/v); 1 (8). To a solution of (S)-5-(aminomethyl)-3-(4-bromo-3-fluorophenyl)oxazolidin-2-one (1.0 equiv), 2-(methylsulfonyl) pyridine-5-boronic acid (1.2 equiv), and potassium phosphate tribasic (2.0 equiv) in THF (1M) was added the second-generation XPhos precatalyst (0.1 equiv) under an Ar atmosphere.…”

“…Oxazolidinone antibiotics such as linezolid are known to be efficacious for the treatment of tuberculosis (TB) through clinical studies of patients with a highly drug-resistant disease. − Unfortunately, linezolid has an unacceptable side-effect profile upon prolonged exposure, limiting its use in TB to only the most drug-resistant cases. − Such side-effects include bone marrow suppression, painful peripheral neuropathies, and optic neuropathies and are thought to be mechanism-related. − Although these side-effects are often reversible with careful management, they effectively limit the use of linezolid to the population of patients infected with a highly drug-resistant disease. Linezolid inhibits protein synthesis by binding to the 50S ribosomal subunit involved in bacterial protein synthesis .…”

Update on drug treatments for multidrug resistant tuberculosis

“…There was one sudden death in this group and two other potential participants in the cohort also died suddenly with no prior evidence of QTc prolongation but neither occurred in participants on both drugs. Non-TB co-medication and electrolyte disturbance were identified as potentially important additional risk factors and the authors suggested that more evidence-based strategies for risk-stratified ECG monitoring are needed [20 ▪ ,21 ▪ ].…”