Randomized pilot trial of 8 weeks of bedaquiline (TMC207) treatment for MDR-TB

Long-term outcome, tolerability, and effect on emergence of drug resistance



The 2-year follow-up results for a randomized placebo-controlled study of 47 patients with multidrug-resistant pulmonary tuberculosis treated with either the new diarylquinoline TMC207, recently renamed bedaquiline, or placebo, added to the first 8 weeks of a background regimen, are presented. Bedaquiline significantly reduced the time to culture conversion over 24 weeks (hazard ratio, 2.253; 95% confidence interval, 1.08 to 4.71; P = 0.031). With the exception of nausea reported in 26% of patients receiving bedaquiline and none receiving placebo, adverse events occurred at similar frequencies in both groups of patients: bilateral hearing impairment, extremity pain, acne, and noncardiac chest pain occurred in 13 and 21%, 17 and 13%, 9 and 17%, and 4 and 17% of patients, respectively, receiving bedaquiline or placebo. Excluding resistance to ethambutol and ethionamide, only one patient receiving bedaquiline acquired resistance to companion drugs, but five patients receiving placebo (4.8% versus 21.7%; P = 0.18) acquired resistance to companion drugs, and resistance to ofloxacin was acquired in four patients receiving placebo and none receiving bedaquiline (0% versus 22%; 0 = 0.066). In all, 23 patients (49%), including 13 receiving placebo (54%) and 10 receiving bedaquiline (44%), discontinued the study prior to its completion, 12 during the first 24 weeks of treatment. Eight subjects were withdrawn for noncompliance or default, and seven withdrew consent, citing the rigorous program of investigations for safety and pharmacokinetic monitoring. Bedaquiline may contribute to the management of multidrug-resistant tuberculosis by effecting more rapid sputum culture negativity and by preventing acquired resistance to companion drugs.

A. H. Diacona, P. R. Donalda, A. Pymb, M. Grobuschc, R. F. Patientiaa, R. Mahanyeleb, N. Bantubanic, R. Narasimoolooc, T. De Marezd, R. van Heeswijke, N. Lounise, P. Meyvische, K. Andriese and D. F. McNeeleyd

aFaculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa
Medical Research Council, Durban, South Africa
Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Tibotec, Inc., Yardley, Pennsylvania, USA
Tibotec BVBA, Mechelen, Belgium

Antimicrobial Agents and Chemotherapy



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By A. H. Diacon et al.

Published: May 21, 2012, 9:56 p.m.

Last updated: May 22, 2012, 1:07 a.m.

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