Outcomes of modified all-oral 9-month treatment regimen for rifampicin-resistant tuberculosis in Belarus

Abstract

<b>Background:</b> Treatment success for patients with rifampicin resistant (RR) TB was only 70% in Belarus in 2017. Modified shorter all-oral treatment regimen was developed by Republican Scientific and Practical Centre on Pulmonology and Phthisiatry of Belarus following WHO recommendations on priority grouping of anti-TB medicines for RR-TB treatment. <b>Objective:</b> To summarize the initial outcomes and its determinants of modified shorter treatment regimen for laboratory-confirmed RR and fluoroquinolone sensitive TB patients in programmatic conditions. <b>Methods:</b> This was a prospective study of standardized regimen containing bedaquiline, levofloxacin, linezolid, clofazimine and cycloserine. Bedaquiline was used for 24 weeks, while remaining medicines were used for 9 months. <b>Results:</b> Of 222 patients who met the study inclusion criteria and were successively enrolled from 2018 to 2019, 90,1% had bacteriologically favourable outcome, 4,1% died, 1,3% failed and 4,5% were lost to follow-up. The treatment success was: - significantly higher among patients who converted to smear negative during the first month of treatment (OR=5, 95% CI 1.92-13.7); - not significantly affected by BMI, co-infections with HIV or hepatitis C; - significantly lower among patients with bilateral pulmonary cavitary lesions at treatment start (OR=0.29, 95% CI 0.1-0.7) and those, who was not converted to smear negative by the end of second month of treatment (0.59, 95% CI 0.3-0.9). <b>Conclusions:</b> Modified shorter all-oral RR-TB regimen shows excellent treatment outcomes. Patients with radiologically extensive disease at treatment start and those, with later conversion to smear negative&nbsp;have lower chances for cure.