Effectiveness of a bedaquiline, linezolid, clofazimine ‘core’ for multidrug-resistant TB

Zeng C.; Hernán M.A.; Trevisi L.; Sauer S.; Mitnick C.D.; Hewison C.; Bastard M.; Khan P.; Seung K.J.; Rich M.L.; Law S.; Kikvidze M.; Kirakosyan O.; Miankou A.; Thit P.; Mamsa S.; Janmohamed A.; Melikyan N.; Ahmed S.; Vargas D.; Binegdie A.B.; Temirova K.; Oyewusi L.; Philippe K.; Vilbrun S.C.; Khan U.; Huerga H.; Franke M.F. · IJTLD Open (2025) · DOI: 10.5588/ijtldopen.24.0515

Resumen

BACKGROUND: Treatment outcomes may be compro-mised among individuals with multidrug/rifampicin-resistant TB (MDR/RR-TB) with fluoroquinolone (FQ) resistance. Among people in whom an FQ was unlikely to be effective, we compared the effectiveness of longer indi-vidualised regimens comprised of bedaquiline (Bdq) for 5–8 months, linezolid, and clofazimine to those reinforced with at least 1 Group C drug and/or longer Bdq duration. METHODS: We emulated a target trial to compare the effectiveness of initiating and remaining on the core regimen to a regimen reinforced with 1) Bdq for ≥9 months, 2) Bdq for ≥9 months, and delamanid (Dlm), 3) imipenem (Imp), 4) a second-line injectable, or 5) Bdq for ≥9 months, Dlm and Imp. We used cloning, censoring, and inverse-probability weighting to estimate the probabilities of successful treatment. RESULTS: Adjusted probabilities of successful treatment ranged from 0.75 (95% CI 0.61–0.89) to 0.84 (95% CI 0.76–0.91). Ratios of treatment success ranged from 1.01 for regimens reinforced with Bdq ≥9 months (95% CI 0.79–1.28) and Bdq ≥9 months plus Dlm (95% CI 0.81–1.31) to 1.11 for regimens reinforced with an in-jectable (95% CI 0.92–1.39) and Bdq ≥9 months, Dlm and Imp (95% CI 0.90–1.41). CONCLUSIONS: Some reinforced regimens had mod-estly higher treatment success rates, but estimates were imprecise. Additional studies of strategies for maximising treatment success among individuals with FQ resistance are needed.