Comparative effectiveness of shorter regimen with oral bedaquiline or injectable on treatment outcomes and mortality among patients with multidrug-resistant tuberculosis in Guinea: A retrospective cohort study

Objectives: Results of clinical trials indicate that oral bedaquiline, instead of an injectable drug to treat rifampicin-resistant tuberculosis (RR-TB), is associated with significant improvement in treatment success and mortality 24 months after treatment initiation. We aimed to compare treatment success and mortality in patients treated for multidrug-resistant tuberculosis (MDR-TB) with shorter oral bedaquiline-containing versus injectable regimens in Guinea. Materials and Methods: We enrolled patients with RR-TB who were treated with an MDR-TB treatment regimen from June 2016 to June 2022 in three tuberculosis (TB) centers in Guinea. The primary outcome was mortality, and the secondary outcomes were treatment success and loss of follow-up. A based on average treatment effect on the treated propensity score on age, sex, geographic site, previous TB treatment, acid-fast-bacilli smear-positivity, and human immunodeficiency virus-infection status was used to account for confounding bias. Cox and logistic regression models were used to obtain adjusted hazard ratios (HR) and odds ratios (OR). Results: 1112 patients treated for MDR-TB during the study period were analyzed: 253 in the bedaquiline group and 859 in the injectable group. Fifteen patients (5.9%) were lost to follow-up, 18 (6.7%) had treatment failure or recurrence, and 46 died (18.2%). A 175 (69.2%) had treatment success in the bedaquiline group, compared with 57 (6.6%), 21 (2.4%), 162 (18.9%), and 619 (72.1%) in the injectable group, respectively. In the adjusted analyses, the bedaquiline-containing regimen was associated with a significant reduction of all-cause mortality (HR: 0.62, 95% confidence interval CI]: 0.42–0.91), a higher probability of treatment success (OR: 1.08, 95% CI: 1.00–1.17), and a similar risk of loss to follow-up (HR: 0.62, 95% CI: 0.32–1.22) as compared with the injectable group. Conclusion: In real-life conditions, a short oral bedaquiline regimen was associated with lower odds of death and higher odds of treatment success among patients with MDR-TB. These findings support the use of short bedaquiline-containing regimens until a new BPaLM regimen is widely available.