K: Tuberculosis and other Mycobacterial Infections
Oral Abstract Submission
Background : Bedaquiline and delamanid are new and much needed treatment options for drug-resistant tuberculosis (TB); however, there are limited data guiding their use and no direct comparison of the two drugs. We thus sought to compare the clinical outcomes of patients with drug-resistant tuberculosis receiving either a bedaquiline- or delamanid-based treatment regimen.
Methods : A prospective observational study among patients with drug-resistant pulmonary TB in the country of Georgia from 2015-17. Patients receiving bedaquiline or delamanid were eligible to be enrolled. Monthly sputum cultures and MIC testing on Mycobacterium tuberculosis isolates were performed. Clinical outcomes included time to culture conversion, rate of acquired drug resistance and treatment outcomes.
Among 156 patients with MDR-TB who were approached, 100 were enrolled, and 95 were receiving a bedaquiline (n=64) or delamanid (n=31) based regimen and included in the study. Patients receiving bedaquiline or delamanid were similar with regards to age, BMI, substance use, comorbidities, rate of cavitary disease, and extensively drug resistant (XDR) TB. Rates of additional Class A drug use including linezolid (78 vs. 81%) and a fluoroquinolone (39 vs. 36%) were similar and the mean effective drugs received per group was 4 (IQR 3-4, p=0.33). Median drug duration was 171 days for bedaquiline and 182 days for delamanid; no patient discontinued due to QTC prolongation. Adjusted cumulative culture conversion rates at 60 days (64% vs. 48%, p=0.14) and 180 days (95% vs. 77%, p=0.02) were higher in patients receiving bedaquiline compared to delamanid (see Figure). Rates of acquired drug resistance were higher in patients receiving delamanid compared to bedaquiline (35 vs. 12%, p<.01). Lastly, patients receiving a bedaquiline-based regimen had higher rates of favorable outcomes as compared to patients receiving delamanid (94% vs. 67%, p<.01).
Conclusion : Patients receiving bedaquiline- and delamanid-based treatment regimens for drug-resistant TB had similar characteristics and those receiving bedaquiline had better clinical outcomes. Our results provide an important first comparison of bedaquiline versus delamanid containing regimens.