Impact of all-oral bedaquiline-based shorter regimens in the treatment of drug-resistant tuberculosis: a systematic review and meta-analysis
Background Drug-resistant tuberculosis (DR-TB) presents a significant global obstacle to TB control efforts, necessitating improved intervention strategies. The introduction of potent drugs, such as bedaquiline (Bdq), has led to the development of shorter treatment regimens. This systematic review a...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2025-04-01
|
| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/10/4/e018220.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850264799287443456 |
|---|---|
| author | Ming Liu Lianping Yang Shanquan Chen Yan He Nathorn Chaiyakunapruk Wai-kit Ming Jing Yu Tesfaye Regassa Feyissa Xiaohan Chen Getahun Fetensa Ebisa Turi Ginenus Fekadu Tadesse Tolossa Firomsa Bekele Xinyao Yi Dinka Dugassa |
| author_facet | Ming Liu Lianping Yang Shanquan Chen Yan He Nathorn Chaiyakunapruk Wai-kit Ming Jing Yu Tesfaye Regassa Feyissa Xiaohan Chen Getahun Fetensa Ebisa Turi Ginenus Fekadu Tadesse Tolossa Firomsa Bekele Xinyao Yi Dinka Dugassa |
| author_sort | Ming Liu |
| collection | DOAJ |
| description | Background Drug-resistant tuberculosis (DR-TB) presents a significant global obstacle to TB control efforts, necessitating improved intervention strategies. The introduction of potent drugs, such as bedaquiline (Bdq), has led to the development of shorter treatment regimens. This systematic review and meta-analysis aimed to examine the impact of these regimens, synthesising data from recent clinical trials and observational studies.Methods We searched multiple databases, including Medline and Scopus, for studies published from 2012 to February 2024. Eligible studies included clinical trials and cohort studies involving adults diagnosed with DR-TB treated with Bdq-based all-oral regimens lasting up to 12 months. Primary outcomes were treatment success rate (TSR) and incidence of serious adverse events (SAEs). We also compared efficacy and safety with longer oral or injectable regimens in control groups. Meta-analyses were conducted to pool event rates and risk ratios (RRs). Subgroup analyses and meta-regression were performed to identify potential sources of heterogeneity.Results Data from 12 studies involving 1902 DR-TB patients across 11 countries were analysed. The pooled TSR was 83% (95% CI 77% to 89%), with mortality, treatment failure and loss to follow-up (LTFU) rates of 5% (3–8), 4% (2–6) and 4% (2–6), respectively. Subgroup analyses showed no significant differences in TSR by DR-TB type or HIV status. The incidence rate of SAE was 19% (13–24), with prolonged corrected QT interval (QTc) in 5% (2–8) of cases. Compared with the control regimens, all-oral Bdq-based shorter regimens significantly improved treatment success (RR 1.22, 1.04–1.43) but reduced mortality (RR 0.73, 0.69–0.99), treatment failure (RR 0.33, 0.32–0.62) and QTc prolongation (RR 0.39, 0.21–0.73).Conclusions All-oral Bdq-based shorter regimens have improved treatment outcomes and significantly advanced DR-TB management. We urge policymakers, clinicians and stakeholders to expand access to and expedite the implementation of these regimens. |
| format | Article |
| id | doaj-art-ca6f3c3c095c4055936918d22295fcfb |
| institution | OA Journals |
| issn | 2059-7908 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-ca6f3c3c095c4055936918d22295fcfb2025-08-20T01:54:37ZengBMJ Publishing GroupBMJ Global Health2059-79082025-04-0110410.1136/bmjgh-2024-018220Impact of all-oral bedaquiline-based shorter regimens in the treatment of drug-resistant tuberculosis: a systematic review and meta-analysisMing Liu0Lianping Yang1Shanquan Chen2Yan He3Nathorn Chaiyakunapruk4Wai-kit Ming5Jing Yu6Tesfaye Regassa Feyissa7Xiaohan Chen8Getahun Fetensa9Ebisa Turi10Ginenus Fekadu11Tadesse Tolossa12Firomsa Bekele13Xinyao Yi14Dinka Dugassa15Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, ChinaSchool of Public Health, Sun Yat-Sen University, Guangzhou, ChinaInternational Centre for Evidence in Disability, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UKDepartment of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, ChinaDepartment of Pharmacotherapy, The University of Utah College of Pharmacy, Salt Lake City, Utah, USADepartment of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, ChinaDepartment of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, ChinaGeohealth Laboratory, Dasman Diabetes Institute, Kuwait City 15462, KuwaitDepartment of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, ChinaSchool of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, EthiopiaDeakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong 3220, Victoria, AustraliaDepartment of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, ChinaDeakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong 3220, Victoria, AustraliaSchool of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, EthiopiaDepartment of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, ChinaSchool of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, EthiopiaBackground Drug-resistant tuberculosis (DR-TB) presents a significant global obstacle to TB control efforts, necessitating improved intervention strategies. The introduction of potent drugs, such as bedaquiline (Bdq), has led to the development of shorter treatment regimens. This systematic review and meta-analysis aimed to examine the impact of these regimens, synthesising data from recent clinical trials and observational studies.Methods We searched multiple databases, including Medline and Scopus, for studies published from 2012 to February 2024. Eligible studies included clinical trials and cohort studies involving adults diagnosed with DR-TB treated with Bdq-based all-oral regimens lasting up to 12 months. Primary outcomes were treatment success rate (TSR) and incidence of serious adverse events (SAEs). We also compared efficacy and safety with longer oral or injectable regimens in control groups. Meta-analyses were conducted to pool event rates and risk ratios (RRs). Subgroup analyses and meta-regression were performed to identify potential sources of heterogeneity.Results Data from 12 studies involving 1902 DR-TB patients across 11 countries were analysed. The pooled TSR was 83% (95% CI 77% to 89%), with mortality, treatment failure and loss to follow-up (LTFU) rates of 5% (3–8), 4% (2–6) and 4% (2–6), respectively. Subgroup analyses showed no significant differences in TSR by DR-TB type or HIV status. The incidence rate of SAE was 19% (13–24), with prolonged corrected QT interval (QTc) in 5% (2–8) of cases. Compared with the control regimens, all-oral Bdq-based shorter regimens significantly improved treatment success (RR 1.22, 1.04–1.43) but reduced mortality (RR 0.73, 0.69–0.99), treatment failure (RR 0.33, 0.32–0.62) and QTc prolongation (RR 0.39, 0.21–0.73).Conclusions All-oral Bdq-based shorter regimens have improved treatment outcomes and significantly advanced DR-TB management. We urge policymakers, clinicians and stakeholders to expand access to and expedite the implementation of these regimens.https://gh.bmj.com/content/10/4/e018220.full |
| spellingShingle | Ming Liu Lianping Yang Shanquan Chen Yan He Nathorn Chaiyakunapruk Wai-kit Ming Jing Yu Tesfaye Regassa Feyissa Xiaohan Chen Getahun Fetensa Ebisa Turi Ginenus Fekadu Tadesse Tolossa Firomsa Bekele Xinyao Yi Dinka Dugassa Impact of all-oral bedaquiline-based shorter regimens in the treatment of drug-resistant tuberculosis: a systematic review and meta-analysis BMJ Global Health |
| title | Impact of all-oral bedaquiline-based shorter regimens in the treatment of drug-resistant tuberculosis: a systematic review and meta-analysis |
| title_full | Impact of all-oral bedaquiline-based shorter regimens in the treatment of drug-resistant tuberculosis: a systematic review and meta-analysis |
| title_fullStr | Impact of all-oral bedaquiline-based shorter regimens in the treatment of drug-resistant tuberculosis: a systematic review and meta-analysis |
| title_full_unstemmed | Impact of all-oral bedaquiline-based shorter regimens in the treatment of drug-resistant tuberculosis: a systematic review and meta-analysis |
| title_short | Impact of all-oral bedaquiline-based shorter regimens in the treatment of drug-resistant tuberculosis: a systematic review and meta-analysis |
| title_sort | impact of all oral bedaquiline based shorter regimens in the treatment of drug resistant tuberculosis a systematic review and meta analysis |
| url | https://gh.bmj.com/content/10/4/e018220.full |
| work_keys_str_mv | AT mingliu impactofalloralbedaquilinebasedshorterregimensinthetreatmentofdrugresistanttuberculosisasystematicreviewandmetaanalysis AT lianpingyang impactofalloralbedaquilinebasedshorterregimensinthetreatmentofdrugresistanttuberculosisasystematicreviewandmetaanalysis AT shanquanchen impactofalloralbedaquilinebasedshorterregimensinthetreatmentofdrugresistanttuberculosisasystematicreviewandmetaanalysis AT yanhe impactofalloralbedaquilinebasedshorterregimensinthetreatmentofdrugresistanttuberculosisasystematicreviewandmetaanalysis AT nathornchaiyakunapruk impactofalloralbedaquilinebasedshorterregimensinthetreatmentofdrugresistanttuberculosisasystematicreviewandmetaanalysis AT waikitming impactofalloralbedaquilinebasedshorterregimensinthetreatmentofdrugresistanttuberculosisasystematicreviewandmetaanalysis AT jingyu impactofalloralbedaquilinebasedshorterregimensinthetreatmentofdrugresistanttuberculosisasystematicreviewandmetaanalysis AT tesfayeregassafeyissa impactofalloralbedaquilinebasedshorterregimensinthetreatmentofdrugresistanttuberculosisasystematicreviewandmetaanalysis AT xiaohanchen impactofalloralbedaquilinebasedshorterregimensinthetreatmentofdrugresistanttuberculosisasystematicreviewandmetaanalysis AT getahunfetensa impactofalloralbedaquilinebasedshorterregimensinthetreatmentofdrugresistanttuberculosisasystematicreviewandmetaanalysis AT ebisaturi impactofalloralbedaquilinebasedshorterregimensinthetreatmentofdrugresistanttuberculosisasystematicreviewandmetaanalysis AT ginenusfekadu impactofalloralbedaquilinebasedshorterregimensinthetreatmentofdrugresistanttuberculosisasystematicreviewandmetaanalysis AT tadessetolossa impactofalloralbedaquilinebasedshorterregimensinthetreatmentofdrugresistanttuberculosisasystematicreviewandmetaanalysis AT firomsabekele impactofalloralbedaquilinebasedshorterregimensinthetreatmentofdrugresistanttuberculosisasystematicreviewandmetaanalysis AT xinyaoyi impactofalloralbedaquilinebasedshorterregimensinthetreatmentofdrugresistanttuberculosisasystematicreviewandmetaanalysis AT dinkadugassa impactofalloralbedaquilinebasedshorterregimensinthetreatmentofdrugresistanttuberculosisasystematicreviewandmetaanalysis |