Tuberc Respir Dis > Volume 84(4); 2021 > Article
Putra and Hidayatullah: Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis: Concern to Bedaquiline
We greatly appreciated the study by Kang et al. [1], which reported successful treatment outcomes and fewer cases lost to follow-up after implementing the public-private mixing period. The data were collected retrospectively over ten years. As we know, multidrug-resistant tuberculosis (MDR-TB) is still a complicated problem worldwide with a high level of treatment failure and mortality, including in Indonesia due to poor adherence and several adverse effects of the drugs. Kang et al. [1], also reported that MDR-TB patients with age older than 65 years old, low body mass index, history of tuberculosis (TB) treatment, bilateral lung lesions, and pre or extensively drug-resistant TB were significantly associated with treatment failure. Interestingly, the administration of bedaquiline or delamanid over 1 month was significantly associated with successful treatment (odds ratio, 5.939; 95% confidence interval, 1.680-20.991; p<0.05) [1]. In a large cohort by Franke et al. [2], 63% of the MDR-TB patients using bedaquiline, delamanid, or both experienced culture conversion within 6 months after the initiation of these drugs. Patients with human immunodeficiency virus (HIV) co-infection, high initial sputum smears, and cavitary lung disease had lower conversion rates than those without these risks. In our country, Indonesia, either bedaquiline or delamanid is used for 6 months if the patient is intolerant, contraindicated, or resistant to a fluoroquinolone or second-line injectable antituberculosis drugs. Fortunately, bedaquiline has been listed in the national program as a part of MDR-TB therapy in Indonesia, whereas delamanid has not [3]. However, studies on the efficacy and safety of bedaquiline for MDR-TB management in Indonesia are very limited. Although bedaquiline is well-tolerated, we should fully consider before administering it. The serious adverse effect of this drug, Frederica-corrected (QTcF) prolongation, should be closely monitored by the pulmonologist and pharmacist [4]. In Indonesia, a study by Soeroto et al. [5], reported that out of 492 MDR-TB patients, 50% of them were successfully treated. Culture conversion of sputum at less than two months was significantly more likely (2.79 times) to indicate successful MDR-TB treatment [5]. At the same time, chronic kidney disease, HIV, and cavitary lesion were risk factors of more prolonged treatment. Unfortunately, bedaquiline was not reported in that study [5]. Although bedaquiline or delanamid had beneficial effects in treating MDR-TB patients, other factors that may inhibit sputum conversion or prolong the duration of therapy should be considered while periodically supervising the side effects.

Notes

Authors’ Contributions

Conceptualization: Putra ON, Hidayatullah AYN. Writing - original draft preparation: Putra ON, Hidayatullah AYN. Approval of final manuscript: all authors.

Conflicts of Interest

The authors declare no conflicts of interest regarding this study.

References

1. Kang Y, Jo EJ, Eom JS, Kim MH, Lee K, Kim KU, et al. Treatment outcomes of patients with multidrug-resistant tuberculosis: comparison of pre- and post-public-private mix periods. Tuberc Respir Dis 2021;84:74-83.
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2. Franke MF, Khan P, Hewison C, Khan U, Huerga H, Seung KJ, et al. Culture conversion in patients treated with bedaquiline and/or delamanid: a prospective multicountry study. Am J Respir Crit Care Med 2021;203:111-9.
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3. Ministry of Health of Indonesia Republic. Programmatic management of drug resistance tuberculosis 2011-2014 [Internet]. Jakarta: Ministry of Health of Indonesia Republic; 2016 [cited 2021 Jul 20]. Available from: https://www.who.int/docs/default-source/searo/indonesia/non-who-publications/programmatic-management-of-drug-resistance-tb-in-indonesia-2011-2014-bahasa.pdf?sfvrsn=aa2e3df1_2.

4. Guglielmetti L, Jaspard M, Le Du D, Lachatre M, Marigot-Outtandy D, Bernard C, et al. Long-term outcome and safety of prolonged bedaquiline treatment for multidrug-resistant tuberculosis. Eur Respir J 2017;49:1601799.
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5. Soeroto AY, Pratiwi C, Santoso P, Lestari BW. Factors affecting outcome of longer regimen multidrug-resistant tuberculosis treatment in West Java Indonesia: a retrospective cohort study. PLoS One 2021;16:e0246284.
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