The efficacy and safety of bedaquiline in multi-drug resistant tuberculosis
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Bedaquiline is a medication recently approved by the FDA for the treatment of multidrug resistant tuberculosis. Due to its recent nature, there exists little information on the efficacy and safety of the drug. A systematic review and meta-analysis was performed to collect what data exist on bedaquiline and assess its efficacy and safety relative to currently recommended regimens, and some specific medications used in those regimens for treating both multidrug resistant and extensively drug-resistant tuberculosis. Nine studies were collected from databases and direct journal searches and pooled to make a sample size of 950 patients receiving a treatment regimen containing bedaquiline. Of these 950 patients on bedaquiline-containing regimens, a high percentage had culture conversion at six months (84.13%, 95% CI = 72.53% - 92.98%), treatment cure (71.86%, 95% CI = 60.94% - 81.60%), and treatment success (70.80%, 95% CI = 61.57% - 79.24%), and a low percentage discontinued bedaquiline (3.65%, 95% CI = 1.98% - 5.81%), or died (6.56%, 95% CI = 4.15% - 9.45%), despite a high number of XDR-TB and HIV co-infected patients. Adverse events due to bedaquiline (21.39%, 95% CI = 11.66% - 33.11%), total severe adverse events (26.50%, 95% CI = 6.98% - 52.86%), hepatotoxicity (14.37%, 95% CI = 2.56 – 33.47%), and QT prolongation percentages (10.37%, 95% CI = 3.19% - 21.01%) were high, but did not lead to bedaquiline discontinuation or death. The efficacy and relative safety of bedaquiline make it a viable option versus current alternative medications and, as part of a regimen, it is far more successful at treating multidrug-, and extensively drug-, resistant tuberculosis than conventional regimens. New treatment regimens only just being put into use, however, such as the Bangladesh regimen, still seem to be superior. More research, including randomized controlled trials, is required to identify how bedaquiline should be incorporated into making multidrug resistant tuberculosis treatment more effective and safe.