Injectable-free regimens containing bedaquiline, delamanid, or both for adolescents with rifampicin-resistant tuberculosis in Khayelitsha, South Africa

Erika Mohr-Holland; Anja Reuter; Jennifer Furin; Anthony Garcia-Prats; Virginia De Azevedo; Vanessa Mudaly; Yulene Kock; Laura Trivino-Duran; Petros Isaakidis; Jennifer Hughes

doi:10.1016/j.eclinm.2020.100290

Injectable-free regimens containing bedaquiline, delamanid, or both for adolescents with rifampicin-resistant tuberculosis in Khayelitsha, South Africa

EClinicalMedicine. 2020 Mar 3:20:100290. doi: 10.1016/j.eclinm.2020.100290. eCollection 2020 Mar.

Authors

Affiliations

¹ Médecins Sans Frontières, Khayelitsha Project and Cape Town Mission, 2nd Floor Isivivana Centre, 1 Julius Tsolo Street, Khayelitsha, Cape Town 7784, South Africa.
² Médecins Sans Frontières, Southern Africa Medical Unit, 4th Floor Deneb House, 368 Main Rd, Observatory, Cape Town 7925, South Africa.
³ Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave., Boston 02115, MA, United States.
⁴ Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa.
⁵ City Health Department, Ntlazane Rd, Khayelitsha, Cape Town 7784, South Africa.
⁶ Provincial Department of Health- Western Cape, 1st floor Norton Rose House, 8 Riebeek Street Cape Town 8001, South Africa.
⁷ National Department of Health, Civitas Building, 222 Thabo Sehume St, CBD, Pretoria 0001, South Africa.

Abstract

Background: Limited data exist on the use of bedaquiline and delamanid in adolescents with rifampicin-resistant tuberculosis (RR-TB). We describe RR-TB treatment of adolescents (10-19 years) with injectable-free regimens containing these drugs in Khayelitsha, South Africa.

Methods: This retrospective study included adolescents initiating injectable-free RR-TB treatment regimens containing bedaquiline and/or delamanid from February 2015 to June 2018. We report adverse events (AEs) of interest, sputum culture conversion (SCC), and final end-of-treatment outcomes.

Findings: Twenty-two patients were included; median age at treatment initiation was 17 years (interquartile range [IQR] 15-18), and six (27%) were HIV-positive (median CD4 count 191 cells/mm3 [IQR 157-204]). Eight (36%) patients had RR-TB with fluoroquinolone resistance; ten (45%), eight (36%), and four (18%) patients received regimens containing bedaquiline, delamanid, or the combination of bedaquiline and delamanid, respectively. The median durations of exposure to bedaquiline and delamanid were 5·6 (IQR 5·5-8·4) and 9·4 (IQR 5·9-14·4) months, respectively. There were 49 AEs of interest which occurred in 17 (77%) patients. Fourteen (64%) patients had pulmonary TB with positive sputum cultures at bedaquiline and/or delamanid initiation; among these SCC at month 6 was 79%. Final end-of-treatment outcomes for the 22 adolescent were: 17 (77%) successfully treated, two (9%) lost-to-follow-up, two (9%) treatment failed, and one (5%) died.

Interpretation: This study found that injectable-free regimens containing bedaquiline and/or delamanid in a programmatic setting were effective and well tolerated in adolescents and should be routinely provided for RR-TB treatment in this age group as recommended by the World Health Organisation.