Bonnet Maryline, Bastard M., du Cros P., Khamraev A., Kimenye K., Khurkhumal S., Hayrapetyan A., Themba D., Telnov A., Sanchez-Padilla E., Hewison C., Varaine F. (2016). Identification of patients who could benefit from bedaquiline or delamanid : a multisite MDR-TB cohort study. International Journal of Tuberculosis and Lung Disease, 20 (2), p. 177-186. ISSN 1027-3719.
Titre du document
Identification of patients who could benefit from bedaquiline or delamanid : a multisite MDR-TB cohort study
Année de publication
2016
Auteurs
Bonnet Maryline, Bastard M., du Cros P., Khamraev A., Kimenye K., Khurkhumal S., Hayrapetyan A., Themba D., Telnov A., Sanchez-Padilla E., Hewison C., Varaine F.
Source
International Journal of Tuberculosis and Lung Disease, 2016,
20 (2), p. 177-186 ISSN 1027-3719
BACKGROUND: The World Health Organization recommends adding bedaquiline or delamanid to multi drug-resistant tuberculosis (MDR-TB) regimens for which four effective drugs are not available, and delamanid for patients at high risk of poor outcome. OBJECTIVE: To identify patients at risk of unfavourable outcomes who may benefit from the new drugs. METHODS: Retrospective cohort study of treatment outcomes involving four to five effective drugs for 1524 months in programmes in Uzbekistan, Georgia, Armenia, Swaziland and Kenya between 2001 and 2011. RESULTS: Of 1433 patients, 48.5% had body mass index (BMI) <18.5 kg/m(2), 72.9% had a high bacillary load, 16.7% were resistant to two injectables, 2.9% were resistant to ofloxacin (OFX) and 3.0% had extensively drug-resistant TB (XDR-TB). Treatment success ranged from 59.7% (no second-line resistance) to 27.0% (XDR-TB). XDR-TB (aOR 8.16, 95%CI 3.22-20.64), resistance to two injectables (aOR 1.90, 95%CI 1.00-3.62) or OFX (aOR 5.56, 95%CI 2.15-14.37), past incarceration (aOR 1.88, 95%CI 1.11-3.2), history of second-line treatment (aOR 3.24, 95%CI 1.53-6.85), low BMI (aOR 2.22, 95%CI 1.56-3.12) and high bacillary load (aOR 2.32, 95%CI 1.15-4.67) were associated with unfavourable outcomes. Patients started on capreomycin rather than kanamycin were more likely to have an unfavourable outcome (aOR 1.54, 95%CI 1.04-2.28). CONCLUSION: In our cohort, patients who may benefit from bedaquiline and delamanid represented up to two thirds of all MDR-TB patients.
Plan de classement
Santé : généralités [050]
;
Entomologie médicale / Parasitologie / Virologie [052]
Description Géographique
ARMENIE ; KENYA ; OUZBEKISTAN ; GEORGIE ; SWAZILAND
Localisation
Fonds IRD [F B010066162]
Identifiant IRD
fdi:010066162
