Safety, efficacy and feasibility of preventive treatment for drug-resistant tuberculosis with moxifloxacin or bedaquiline
Abstract
ABSTRACT Introduction Rates of drug-resistant tuberculosis (TB) are increasing worldwide. TB preventive treatment (TPT) for contacts of active TB patients is essential to halt infection progression and transmission. While newer TPT regimens for drug-sensitive strains are expanding, optimal treatment for contacts exposed to drug-resistant TB (DR-TB) remains unclear. In 2019-2020, Vladimir City, Russia, introduced moxifloxacin and bedaquiline-based TPT regimens to prevent disease development in contacts exposed to DR-TB. Methods We conducted a retrospective cohort study using medical records data that included adult TB contacts, people experiencing homelessness, and persons with HIV who received TPT in Vladimir City, Russia, between 2019 and 2020. Those without TB disease but with indications for TPT were offered one of six regimens, based on drug-susceptible testing results of index patient: Rifapentine/Isoniazid (3HP), Isoniazid (6H), Rifabutin/Isoniazid (3HRb), Rifampicin (4R), Moxifloxacin (4Mfx), or Bedaquiline (3Bdq). Adverse drug reactions (ADRs) were monitored with monthly lab tests and ECGs. Results Over 24 months, 403 people started TPT. No life-threatening ADRs or deaths occurred. The lowest ADR rate and significantly higher completion rate was observed in 3Bdq (n=20, 95.2%) compared to 3HP (n=192, 75.9%, Mid-P exact = .03). The rate of TB disease per 1,000 person-years of observation was four times higher in individuals eligible for TPT who did not start it…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 403 participants or records.
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