Gao JT, Xie L, Ma LP, Shu W, Zhang LJ, Ning YJ, Xie SH, Liu YH, Gao MQ. Prolonged use of bedaquiline in two patients with pulmonary extensively drug-resistant tuberculosis: Two case reports. World J Clin Cases 2021; 9(10): 2326-2333 [PMID: 33869610 DOI: 10.12998/wjcc.v9.i10.2326]
Corresponding Author of This Article
Meng-Qiu Gao, MD, PhD, Director, Doctor, Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, No. 9 Beiguan Street, Tongzhou District, Beijing 101149, China. gaomengqiu@bjxkyy.cn
Research Domain of This Article
Infectious Diseases
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jing-Tao Gao, Wei Shu, Li-Jie Zhang, Yu-Jia Ning, Shi-Heng Xie, Yu-Hong Liu, Clinical Center on TB, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
Li Xie, Li-Ping Ma, Meng-Qiu Gao, Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
Author contributions: Gao JT drafted the manuscript; Xie L and Ma LP collected clinical data of the two cases; Zhang LJ and Ning YJ worked with the drug distribution and management; Shu W and Xie SH were responsible for patient education and management; Gao MQ and Liu YH reviewed and edited the manuscript; The final version of the manuscript was approved by all authors; Gao JT, Xie L, and Ma LP are co-first authors and contributed equally to this case report.
Informed consent statement: This study was approved by the Ethics Committee of Beijing Chest Hospital affiliated with Capital Medical University, and the participant signed a written informed consent to agree with the anonymous use of clinical data.
Conflict-of-interest statement: The authors declared that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Meng-Qiu Gao, MD, PhD, Director, Doctor, Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, No. 9 Beiguan Street, Tongzhou District, Beijing 101149, China. gaomengqiu@bjxkyy.cn
Received: October 22, 2020 Peer-review started: October 22, 2020 First decision: December 13, 2020 Revised: December 26, 2020 Accepted: February 4, 2021 Article in press: February 4, 2021 Published online: April 6, 2021 Processing time: 154 Days and 5.8 Hours
Abstract
BACKGROUND
Bedaquiline is among the prioritized drugs recommended by the World Health Organization for the treatment of extensively drug-resistant tuberculosis (XDR-TB). Many patients have not achieved better clinical improvement after bedaquiline is stopped at 24 wk. However, there is no recommendation or guideline on bedaquiline administration beyond 24 wk, which is an important consideration when balancing the benefit of prognosis for XDR-TB against the uncertain safety concerning the newer antibiotics.
CASE SUMMARY
This paper reported 2 patients with XDR-TB (a female of 58 years of age and a female of 18 years of age) who received bedaquiline for 36 wk, as local experience to be shared. The 2 cases had negative cultures after 24 wk of treatment, but lung imaging was still positive. After discussion among experts, the consensus was made to bedaquiline prolongation by another 12 wk. The 36-wk prolonged use of bedaquiline in both cases achieved a favorable response without increasing the risk of cardiac events or new safety signals.
CONCLUSION
Longer regimen, including 36-wk bedaquiline treatment, might be an option for patients with XDR-TB. More studies are needed to explore the effectiveness and safety of prolonged use of bedaquiline for 36 wk vs standard 24 wk in the treatment of multidrug-resistant/XDR-TB or to investigate further the biomarkers and criteria indicative for extension of bedaquline to facilitate clinical use of this novel drug.
Core Tip: In the 2 patients reported here, the longer regimen, including 36-wk bedaquiline treatment, might be an option for patients with extensively drug-resistant tuberculosis. More studies are needed to explore the effectiveness and safety of prolonged use of bedaquiline for 36 wk vs standard 24 wk in the treatment of multidrug-resistant/ extensively drug-resistant tuberculosis and to investigate further the biomarkers and criteria indicative for extension of bedaquline to facilitate clinical use of this novel drug.
