Radiological Resolution of Pulmonary Lesions among Drug-resistant Tuberculosis Patients following Bedaquiline-containing Regimen Therapy: A Meta-analysis of Randomized Clinical Trials

Bedaquiline (BDQ) has been shown to improve the cure rate and accelerate the time to culture conversion in patients with drug-resistant tuberculosis (DR-TB). However, pulmonary lesion improvement based on chest imaging after BDQ treatment has not been evaluated. We aimed to evaluate pulmonary lesion improvement in patients with DR-TB following treatment with BDQ-containing regimens. Five electronic databases (CENTRAL, Clinicaltrials.gov., PubMed, ScienceDirect, and SinoMed) were searched for this meta-analysis of randomized controlled trials (RCTs; PROSPERO: CRD42024571134). RCTs with a BDQ-receiving intervention arm and a BDQ-free control arm that reported radiological outcomes were included. Outcomes of this study were lesion absorption and cavitary closure on imaging. Subgroup analysis was conducted according to study quality (i.e., Jadad scale). Of the 476 retrieved records, eleven RCTs were eligible (pooled participants: 973, 50.2% received BDQ). Lesion improvement (risk ratio [RR] [95% confidence interval (CI)] = 1.51 [1.28-1.78], P = 0.001, I2= 0%) and cavitary closure (RR [95% CI] = 1.40 [1.26-1.55], P = 0.001, I2= 27%) were higher in the BDQ arms compared to controls. Patient improvements were more evident among high-quality RCTs compared to low-quality RCTs. Overall, BDQ-containing regimens improve pulmonary lesions and cavitations among patients with DR-TB.