P-1379. Predictors of Death and Therapeutic Failure in Patients Treated with a Shortened All-Oral Regimen for Multidrug- or Rifampicin-Resistant Tuberculosis (MDR/RR-TB) in Lesotho
Abstract
Abstract Background MDR/RR-TB remains an important contributor to the global TB disease burden. Historically, effective therapy was hindered by prolonged regimens and drug toxicity. Recent clinical trials and observational studies demonstrated the potential of shortened all-oral regimens in improving treatment outcomes, leading the WHO to recommend several standardized 6 and 9-month regimens. Which patients are at high risk for unfavorable outcomes under these regimens is largely unknown. Here, we report clinical and radiographic predictors of treatment failure for a 9-month all-oral regimen implemented in Lesotho. Methods As part of the STEM-TB (NCT05871489) multinational prospective cohort study, we recruited adult participants with bacteriologically confirmed MDR/RR pulmonary TB under operational research conditions. Patients with confirmed fluoroquinolone susceptibility and no drug contraindications were treated with a 9-month regimen containing levofloxacin, bedaquiline, delamanid, linezolid, and clofazimine. We assessed end-of-treatment outcomes and performed logistic regression to evaluate baseline factors that predict death and therapeutic failure. Results Of 237 participants included in efficacy analyses, median age was 41 (IQR:31-56), 70 (30%) were female, and 147 (62%) were baseline HIV positive. Clinical cure was achieved in 215 (91%) individuals, and therapeutic failure or TB-related mortality was noted in 22 (9%). Baseline patient features inversely related to…
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: 237 participants or records.
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