New generation of drugs show early efficacy against drug-res
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New treatment regimens for multidrug-resistant tuberculosis (MDR-TB) have shown early effectiveness in 85 percent of patients in a cohort that included many people with serious comorbidities that would have excluded them from clinical trials, according to the results of a new international study.

The endTB observational study is the largest multicountry cohort of patients with rifampin-resistant/MDR-TB treated in routine care, according to WHO guidance, with delamanid- and/or bedaquiline-containing regimens. It reports frequency of sputum culture conversion within six-months of treatment initiation and risk factors for non-conversion.

Researchers included patients with a positive baseline culture who initiated a first endTB regimen prior to April 2018. Two consecutive negative cultures collected more than 15 days apart constituted culture conversion.

Findings: 1,109 patients initiated a multidrug treatment containing bedaquiline (63%), delamanid (27%) or both (10%). Of these, 939 (85%) experienced culture conversion within six months. In adjusted analyses, patients with HIV had a lower probability of conversion than patients without HIV. Patients with both cavitary disease and highly positive sputum smear had a lower probability of conversion relative to patients without either. Hepatitis C infection, diabetes mellitus/glucose intolerance, and baseline resistance were not associated with conversion.

Conclusively, Frequent sputum conversion in patients with rifampin-resistant/MDR-TB who were treated with bedaquiline and/or delamanid underscores the need for urgent expanded access to these drugs. There is a need to optimize treatment for patients with HIV and extensive disease.

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