Bedaquiline in the treatment of multidrug-resistant tuberculosis: a subanalysis in Korean population

Although treatment success for multidrug-resistant tuberculosis (MDR-TB) in Korea has increased owing to a national TB program and insurance coverage, Korea still has the highest TB incidence and associated mortality among the OECD Countries. Further, the final treatment outcome with bedaquiline in Korea has not been evaluated. In the present study, we compared the safety and efficacy of bedaquiline in Korean population, with advanced resistant profile, with those of the total population of the C209 trial to obtain valuable information. In the C209 trial, patients with MDR-TB received bedaquiline for 24 weeks in combination with optimized background regimen and all patients were followed up for 96 weeks after the last administration of bedaquiline. A subgroup analysis was performed in 21 Korean patients enrolled in the C209 trial. The baseline characteristics were similar between the two groups, except the drug-susceptibility pattern. The proportion of patients with pre-extensively drug resistant (XDR)/XDR-TB was 61.9% and 35.2% in the Korean population and total C209 population, respectively. Aminoglycosides, later generation fluoroquinolones, cycloserine, and linezolid were the most frequent drugs concomitantly used during bedaquiline treatment. The culture conversion rate was similar at the end of bedaquiline treatment (80% vs. 79.5%) and at 120 weeks (75% vs. 72.2%). The frequency and type of adverse events were similar between the two groups. In conclusion, bedaquiline showed similar efficacy and safety in Korean patients with MDR-TB despite their advanced drug-resistant profile, likely due to the effective companion drugs such as linezolid and later generation fluoroquinolones.