Definitive outcomes in patients with rifampicin-resistant tuberculosis treated in Niger from 2012 to 2019: A retrospective cohort study

• Published in: International health 2023-05, Vol.15 (3), p.258-264
• Main Authors: Souleymane, Mahamadou Bassirou, Decroo, Tom, Mamadou, Saïdou, Soumana, Alphazazi, Lawan, Ibrahim Mamane, Gagara-Issoufou, Assiatou, Adehossi, Eric, Ortuño-Gutiérrez, Nimer, Lynen, Lutgarde, Rigouts, Leen, de Jong, Bouke Catherine, Van Deun, Armand, Piubello, Alberto
• Format: Article
• Language: English
• Subjects: Antitubercular Agents - therapeutic use; Fluoroquinolones - pharmacology; Fluoroquinolones - therapeutic use; Humans; Niger; Original; Retrospective Studies; Rifampin - therapeutic use; Treatment Outcome; Tuberculosis, Multidrug-Resistant - drug therapy
• ISSN: 1876-3413; 1876-3405
• DOI: 10.1093/inthealth/ihac016

Abstract Background Outcomes of retreatment for rifampicin-resistant tuberculosis (RR-TB) are rarely reported. We report ‘definitive outcomes’ after a cascade approach to RR-TB treatment. After a bacteriologically adverse outcome for the 9-months fluoroquinolone-based Short Treatment Regimen (STR), patients were retreated with a bedaquiline-based regimen (BDQ-regimen). Methods A Retrospective cohort study of RR-TB patients treated with the STR during 2012–2019 and retreated with a BDQ-regimen in case of failure or relapse was conducted. Definitive relapse-free cure took into account BDQ-regimen outcomes. Results Of 367 patients treated with the STR, 20 (5.4%) experienced failure or relapse. Out of these 20 patients, 14 started a BDQ-regimen, of whom none experienced failure or relapse. Definitive end of treatment outcomes of STR after revising with third-line BDQ-regimen outcomes, 84.7% (311/367) were cured relapse-free, 10.6% (39/367) died during treatment and 3.0% (11/367) were lost to follow-up during treatment with either the STR or BDQ-regimen. Six patients (1.6%; 6/367) with STR failure/relapse died before starting a BDQ-regimen. No patient had definitive treatment failure or relapse and remained without treatment. Conclusions If fluoroquinolone resistance is excluded or rare, it is beneficial to use fluoroquinolone as the core drug for a first RR-TB treatment regimen and to safeguard bedaquiline for those in need of retreatment.