BMC Medicine (Sep 2024)

Nine months of bedaquiline, linezolid, levofloxacin, clofazimine, and cycloserine chemotherapy for rifampicin/multidrug-resistant tuberculosis: a multicenter, randomized, open-label non-inferiority trial in China

  • Yanhua Song,
  • Wei Shu,
  • Yi Pei,
  • Juan Du,
  • Guihui Wu,
  • Hua Wang,
  • Fengling Mi,
  • Fangchao Liu,
  • Liping Ma,
  • Li Xie,
  • Zhongshun Kong,
  • Xiaoguang Wu,
  • Rongmei Liu,
  • Hongmei Chen,
  • Hua Li,
  • Qiping Ge,
  • Lihui Nie,
  • Zizheng Lv,
  • Xuerui Huang,
  • Mingwu Li,
  • Mingying Jiang,
  • Xiaohong Chen,
  • Qingshan Cai,
  • Wei Chen,
  • Yanmei Liu,
  • Yanfang Miao,
  • Yan Tang,
  • Yu Chen,
  • Shujun Geng,
  • Quanying Zhou,
  • Yuhong Liu,
  • Yu Pang,
  • Mengqiu Gao

DOI
https://doi.org/10.1186/s12916-024-03633-3
Journal volume & issue
Vol. 22, no. 1
pp. 1 – 8

Abstract

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Abstract Background We concurrently developed a prospective study to assess clinical outcomes among patients receiving 9-month bedaquiline (BDQ)-containing regimens, aiming to provide valuable data on the use of this short-course regimen in China. Methods This open-label, randomized, controlled, multicenter, non-inferiority trial was conducted at sixteen hospitals, and enrolled participants aged 18 years and older with pulmonary rifampicin/multidrug tuberculosis. Participants were randomly assigned, in a 1:1 ratio. Individuals within the standard-regimen group received 6 months of BDQ, linezolid, levofloxacin, clofazimine, and cycloserine plus 12 months of levofloxacin, and any three potentially effective drugs from clofazimine, cycloserine pyrazinamide, ethambutol and protionamide, whereas individuals within shorter-regimen group received 9 months of BDQ, linezolid, levofloxacin, clofazimine and cycloserine. The primary outcome was the percentage of participants with a composite unfavorable outcome (treatment failure, death, treatment discontinuation, or loss to follow-up) by the end of the treatment course after randomization in the modified intention-to-treat population. The noninferiority margin was 10%. This trial was registered with www.chictr.org.cn , ChiCTR2000029012. Results Between Jan 1, 2020, and Dec 31, 2023, 264 were screened and randomly assigned, 132 of 264 participants were assigned to the standard-regimen group and 132 were assigned to the shorter-regimen. Thirty-three (12.55%) of 264 participants were excluded from the modified intention-to-treat analysis. As a result, 231 participants were included in the modified intention-to-treat analysis (116 in the standard-regimen group and 115 in the shorter-regimen group).In the modified intention-to-treat population, unfavorable outcomes were reported in 19 (16.5%) of 115 participants for whom the outcome was assessable in the shorter-regimen group and 26 (22.4%) of 116 participants in the standard care group (risk difference 5.9 percentage points (97.5% CI − 5.8 to 17.5)). One death was reported in the standard-regimen group. The incidence of QTcF prolongation in the shorter-regimen group (22.6%, 26/115) was similar to the standard-regimen group (24.1%, 28/116). Conclusions The 9-month, all-oral regimen is safe and efficacious for the treatment of pulmonary rifampicin/multidrug-resistant tuberculosis. The high incidence of QTc prolongation associated with the use of BDQ highlights the urgent need of routine electrocardiogram monitoring under treatment with BDQ-containing regimens in the Chinese population.

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