Efficacy and safety of bedaquiline containing regimens in patients of drug-resistant tuberculosis: An updated systematic review and meta-analysis

Obaid Ur Rehman; Eeshal Fatima; Abraish Ali; Umar Akram; Abdulqadir Nashwan; Faryal Yunus

doi:10.1016/j.jctube.2023.100405

Efficacy and safety of bedaquiline containing regimens in patients of drug-resistant tuberculosis: An updated systematic review and meta-analysis

J Clin Tuberc Other Mycobact Dis. 2023 Dec 1:34:100405. doi: 10.1016/j.jctube.2023.100405. eCollection 2024 Feb.

Authors

Obaid Ur Rehman¹, Eeshal Fatima¹, Abraish Ali², Umar Akram³, Abdulqadir Nashwan⁴, Faryal Yunus⁵

Affiliations

¹ Department of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan.
² Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
³ Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan.
⁴ Hamad Medical Corporation, Doha, Qatar.
⁵ Department of Pathology, Services Institute of Medical Sciences, Lahore, Pakistan.

Abstract

Background: Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis and leads to serious complications if left untreated. Some strains of Mycobacterium tuberculosis are multi-drug resistant and require treatment with newer drugs. Bedaquiline based treatment regimens have been used in patients who are diagnosed with drug resistant tuberculosis. The aim of this study is to assess the efficacy and safety profile of bedaquiline-based treatment regimens using a systematic review of existing literature and meta-analysis.

Methods: In this study, an electronic search was carried out on PubMed, ScienceDirect, and Cochrane library to find relevant literature from March 2021 onwards. Random-effects model was used to assess pooled treatment success rate and 95 % CIs. p-value of <0.05 was suggestive of publication bias. The review is registered with PROSPERO: CRD42023432748.

Results: A total of 543 articles were retrieved by database searching, out of which 12 new studies met the inclusion criteria. The total number of articles included in the review was 41 including 36 observational studies (having a total of 9,934 patients) and 5 experimental studies (having a total of 468 patients). The pooled treatment success rate was 76.9 % (95 % CI, 72.9-80.4) in the observational studies and 81.7 % (95 % CI, 67.2-90.7) in the experimental studies. Further subgroup analysis was done on the basis of treatment regimens containing bedaquiline only and treatment regimens containing bedaquiline and delamanid. The pooled treatment success rate in the studies consisting of patients who were treated with regimens containing bedaquiline only was 78.4 % (95 % CI, 74.2-82.1) and 73.6 % (95 % CI, 64.6-81.0) in studies consisting of patients who were treated with regimens containing bedaquiline and delamanid. There was no evidence of publication bias.

Conclusions: In patients of drug resistant tuberculosis having highly resistant strains of Mycobacterium tuberculosis undergoing treatment with bedaquiline-based regimen demonstrate high rates of culture conversion and treatment success. Moreover, the safety profile of bedaquiline-based regimens is well-established in all studies.

Keywords: Bedaquiline; Drug resistance; Efficacy; Meta-analysis; Multidrug resistant; Tuberculosis.

Publication types

Review