%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Bonnet, Maryline
%A Bastard, M.
%A du Cros, P.
%A Khamraev, A.
%A Kimenye, K.
%A Khurkhumal, S.
%A Hayrapetyan, A.
%A Themba, D.
%A Telnov, A.
%A Sanchez-Padilla, E.
%A Hewison, C.
%A Varaine, F.
%T Identification of patients who could benefit from bedaquiline or delamanid : a multisite MDR-TB cohort study
%D 2016
%L fdi:010066162
%G ENG
%J International Journal of Tuberculosis and Lung Disease
%@ 1027-3719
%K treatment ; regimens ; resource-limited ; drug resistance ; tuberculosis ; outcomes
%K ARMENIE ; KENYA ; OUZBEKISTAN ; GEORGIE ; SWAZILAND
%M ISI:000368966500010
%N 2
%P 177-186
%R 10.5588/ijtld.15.0962
%U https://www.documentation.ird.fr/hor/fdi:010066162
%> https://www.documentation.ird.fr/intranet/publi/2016/02/010066162.pdf
%V 20
%W Horizon (IRD)
%X 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.
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