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      Effectiveness and safety of regimen containing bedaquiline and delamanid in patients with drug-resistant tuberculosis

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          Abstract

          Background:

          Bedaquiline and delamanid have been included in the individualized treatment regimen (ITR) to treat patients with drug-resistant tuberculosis (DR-TB).

          Objective:

          The objective of this study is to compare the effectiveness of sputum culture conversion and the safety of ITR containing bedaquiline and delamanid.

          Methods:

          Data were collected retrospectively from medical records of DR-TB patients who received ITR between January 2020 and December 2021. Patients were divided into bedaquiline and bedaquiline-delamanid groups. Sputum culture was evaluated until 6 months of treatment. Measurement of QTc interval, renal and liver function test, and serum potassium were evaluated to assess safety during the study period. We used Chi-square to analyze a difference in cumulative culture conversion; meanwhile, Wilcoxon and Mann–Whitney tests were used to analyze differences in laboratory data for each and between the two groups, respectively.

          Results:

          Fifty-one eligible DR-TB patients met the inclusion criteria, 41 in the bedaquiline and 10 in bedaquiline-delamanid group. 43/51 patients had a positive culture at baseline. After 6 months of treatment, 42/43 DR-TB patients (97.6%) had sputum culture conversion and no difference between the two groups ( P ≥ 0.05). QTc interval within normal limit and no patient had a QTc >500 ms during the study period. Creatinine levels significantly differed between the two groups 6 months after treatment ( P < 0.05).

          Conclusion:

          DR-TB patients who received all oral ITR containing bedaquiline and or delamanid demonstrated favorable sputum conversion with a tolerable safety profile.

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          Most cited references18

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          Risk factors for multidrug-resistant tuberculosis: A worldwide systematic review and meta-analysis

          Background Since multidrug-resistant tuberculosis (MDR-TB) is a significant public health problem worldwide, identifying associated risk factors is critical for developing appropriate control strategies. Methods A systematic review and meta-analysis was conducted for identifying factors independently predicting MDR-TB. The random-effects model was used to determine pooled odds ratios (ORs) and respective 95% confidence intervals (CIs) for the related factors. Results Of the 2301 retrieved reports, 28 studies were analyzed, assessing 3152 MDR-TB and 52715 DS-TB cases. Totally 22 related factors were analyzed. The pooled ORs were 1.478 (95%CI 1.077–2.028) for positive sputum AFB smear, 1.716 (95%CI 1.149–2.564) for lung cavity, 6.078 (95%CI 2.903–12.725) for previous TB disease and 5.427 (95%CI 3.469–8.490) for a history of anti-TB therapy. All Z test p values were below 0.05, indicating these parameters were significantly associated with MDR-TB. Conclusions Positive sputum AFB smear, lung cavity, previously diagnosed TB and a history of anti-TB therapy are significant risk factors for MDR-TB, which are independent of the clinical setting worldwide. Increased attention should be paid to cases with such parameters to achieve more effective TB control and avoid MDR-TB through the development of a global policy.
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            Proposed Linezolid Dosing Strategies to Minimize Adverse Events for Treatment of Extensively Drug-Resistant Tuberculosis

            Background We evaluated Nix-TB trial data (NCT02333799, N = 109) to provide dosing recommendations to potentially minimize linezolid toxicity in patients with extensively drug-resistant tuberculosis. . Methods A pharmacokinetic model and toxicodynamic models for peripheral neuropathy, hemoglobin, and platelets were developed. Simulations compared safety outcomes for daily linezolid of 1200 and 600 mg, with and without dose adjustments for toxicity. Severe neuropathy was based on symptom scores from the Brief Peripheral Neuropathy Screen. Severe anemia and thrombocytopenia were defined as ≥ grade 3 adverse events according to the NIAID Division of Microbiology and Infectious Disease Adult Toxicity table. Results Predicted concentration-time profiles were a major predictor in all toxicodynamic models. Simulations showed higher percentages of patients with severe neuropathy (median, 19%; 90% confidence interval [CI], 17%–22% vs 5%, 4%–7%) and severe anemia (15%, 12%–17% vs 1%, 0%–2%) between 1200 and 600 mg daily linezolid. No differences in severe thrombocytopenia were observed (median, <1% for both daily doses). Generally, neuropathy occurred after 3 to 6 months of treatment and, with protocol-specified management, reversed within 15 months after onset. Simulations indicated that a >10% decrease in hemoglobin level after 4 weeks of treatment would have maximum sensitivity (82%) and specificity (84%) for predicting severe anemia. Reducing the dose from 1200 to 600 mg triggered by this marker may prevent 60% (90% CI, 45%–72%) of severe anemia. Conclusions Simple neuropathy symptom and hemoglobin monitoring may guide linezolid dosing to avoid toxicities, but prospective testing is needed to confirm the benefit-to-risk ratio. Limited information is available about optimal linezolid dosing strategies in patients with tuberculosis. We analyzed data from Nix-TB to describe the relationship between linezolid exposure and major toxicities. We provide practical recommendations about linezolid dosing to minimize severe adverse events.
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              Interim treatment outcomes in multidrug-resistant tuberculosis using bedaquiline and/or delamanid in South Korea.

              The Korea Centers for Disease Control & Prevention has implemented a review process for the approval of new drugs used to treat patients with multidrug-resistant tuberculosis (MDR-TB) since September 2016. Therefore, this study aimed to evaluate the efficacy and safety of these new drugs bedaquiline (Bdq) and delamanid (Dlm).
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                Author and article information

                Journal
                Perspect Clin Res
                Perspect Clin Res
                PCR
                Perspect Clin Res
                Perspectives in Clinical Research
                Wolters Kluwer - Medknow (India )
                2229-3485
                2229-5488
                Apr-Jun 2024
                11 September 2023
                : 15
                : 2
                : 89-93
                Affiliations
                [1 ]Doctoral Program of Pharmacy, Faculty of Pharmacy, Airlangga University, Surabaya, Indonesia
                [2 ]Study Program of Pharmacy, Faculty of Medicine, Hang Tuah University, Surabaya, Indonesia
                [3 ]Faculty of Pharmacy, Airlangga University, Surabaya, Indonesia
                [4 ]Faculty of Medicine, Hang Tuah University, Surabaya, Indonesia
                [5 ]Department of Pulmonology and Respiratory Medicine, Dr. Soetomo Hospital, Surabaya, Indonesia
                Author notes
                Address for correspondence: Dr. Yulistiani Yulistiani, Dr. Ir. H. Soekarno, Surabaya, East Java, Indonesia. E-mail: yulistianifarmasiunair@ 123456gmail.com
                Article
                PCR-15-89
                10.4103/picr.picr_1_23
                11101004
                38765544
                95bf4f01-c4d9-4167-be4d-dcd755967e6c
                Copyright: © 2023 Perspectives in Clinical Research

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 02 January 2023
                : 11 February 2023
                : 13 February 2023
                Categories
                Original Article

                Medicine
                bedaquiline,delamanid,effectiveness,individualized treatment regimen,safety
                Medicine
                bedaquiline, delamanid, effectiveness, individualized treatment regimen, safety

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