Publication: Safety of Treatment Regimens Containing Bedaquiline and Delamanid in the endTB Cohort

September 29th, 2022

Background: Safety of treatment for multidrug-resistant tuberculosis (MDR/RR-TB) can be an obstacle to treatment completion. Evaluate safety of longer MDR/RR-TB regimens containing bedaquiline and/or delamanid.

Methods: Multicentre (16 countries), prospective, observational study reporting incidence and frequency of clinically relevant adverse events of special interest (AESIs) among patients who received MDR/RR-TB treatment containing bedaquiline and/or delamanid. The AESIs were defined a priori as important events caused by bedaquiline, delamanid, linezolid, injectables, and other commonly used drugs. Occurrence of these events was also reported by exposure to the likely causative agent.

Results: Among 2296 patients, the most common clinically relevant AESIs were peripheral neuropathy (26.4%), electrolyte depletion (26.0%), and hearing loss (13.2%) with an incidence per 1000 person months of treatment, 1000 person-months of treatment 21.5 (95% confidence interval [CI]: 19.8-23.2), 20.7 (95% CI: 19.1-22.4), and 9.7 (95% CI: 8.6-10.8), respectively. QT interval was prolonged in 2.7% or 1.8 (95% CI: 1.4-2.3)/1000 person-months of treatment. Patients receiving injectables (N = 925) and linezolid (N = 1826) were most likely to experience events during exposure. Hearing loss, acute renal failure, or electrolyte depletion occurred in 36.8% or 72.8 (95% CI: 66.0-80.0) times/1000 person-months of injectable drug exposure. Peripheral neuropathy, optic neuritis, and/or myelosuppression occurred in 27.8% or 22.8 (95% CI: 20.9-24.8) times/1000 patient-months of linezolid exposure.

Conclusions: AEs often related to linezolid and injectable drugs were more common than those frequently attributed to bedaquiline and delamanid. MDR-TB treatment monitoring and drug durations should reflect expected safety profiles of drug combinations.

Authors: Catherine Hewison, Uzma Khan, Mathieu Bastard, Nathalie Lachenal, Sylvine Coutisson, Elna Osso, Saman Ahmed, Palwasha Khanz, Molly F Franke, Michael L Rich, Francis Varaine, Nara Melikyan, Kwonjune J Seung, Malik Adenov, Sana Adnan, Narine Danielyan, Shirajul Islam, Aleeza Janmohamed, Hayk Karakozian, Maureen Kamene Kimenye, Ohanna Kirakosyan, Begimkul Kholikulov, Aga Krisnanda, Andargachew Kumsa, Garmaly Leblanc, Leonid Lecca, Mpiti Nkuebe, Shahid Mamsa, Shrivani Padayachee, Phone Thit, Carole D Mitnick, Helena Huerga

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