Establishing the Safety and Efficacy of Bedaquiline-Containing Regimen for the Treatment of Drug-Resistant Tuberculosis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

• Published in: Pulmonary medicine 2024, Vol.2024 (1), p.5542658
• Main Authors: Jihwaprani, Muhammad Candragupta, Sun, Yipeng, Rizky, Wahyu Choirur, Sula, Idris, Saquib, Nazmus
• Format: Article
• Language: English
• Subjects: Antitubercular Agents - adverse effects; Antitubercular Agents - therapeutic use; Diarylquinolines - adverse effects; Diarylquinolines - therapeutic use; Drug dosages; Drug resistance; Drug resistance in microorganisms; Drug therapy; Humans; Keywords; Meta-analysis; Mortality; Observational studies; Randomized Controlled Trials as Topic; Success; Systematic review; Treatment Outcome; Tuberculosis; Tuberculosis, Multidrug-Resistant - drug therapy; Variables
• ISSN: 2090-1836; 2090-1844; 2090-1844
• DOI: 10.1155/2024/5542658

The risks and benefits of bedaquiline (BDQ) for treatment of drug-resistant tuberculosis (DR-TB) have not been firmly established. We aimed to assess the safety and efficacy of BDQ-containing regimens for the treatment of DR-TB as evidenced in available randomized controlled trials (RCTs). In this systematic review and meta-analysis, five databases (i.e., ClinicalTrials.gov, Cochrane CENTRAL, PubMed, ScienceDirect, and SinoMed) were searched. RCTs among DR-TB patients that had a control arm were eligible. The safety endpoints were all-cause mortality and serious adverse effects (SAEs). Efficacy outcomes were sputum culture conversion rate at 8-12 weeks and 24-26 weeks, treatment success, and time to culture conversion. A total of 476 records were screened; 18 met the eligibility criteria. The pooled analysis included 2520 participants (55.8% received BDQ-containing regimens, = 1408). Pooled safety outcomes showed no significant reduction in all-cause mortality (relative risk [RR] [95%confidence interval (CI)] = 0.94 [0.41-2.20]) or SAEs (RR [95%CI] = 0.91 [0.67-1.23]) in the BDQ-regimen group. Pooled efficacy outcomes showed significantly superior culture conversion rates at 8-12 weeks (RR [95%CI] = 1.35 [1.10-1.65]) and 24-26 weeks (RR [95%CI] = 1.25 [1.15-1.36]), more treatment success (RR [95%CI] = 1.30 [1.17-1.44]), and a 17-day reduction in the time to culture conversion (standardized mean difference [SMD] [95%CI] = -17.46 [-34.82 to -0.11]) in the BDQ-regimen group (reference: non-BDQ regimen). Overall, BDQ regimens showed significant treatment effect against DR-TB but did not reduce mortality or SAEs.