Treatment outcome in patients with MDR-TB treated with bedaquiline containing regimens, Republic of Moldova

<b>Aim:</b> To assess the treatment outcome in patients who received bedaquiline containing MDR-TB treatment regimens in the Republic of Moldova. <b>Methods:</b> We systematically analyzed the national electronic TB database and performed a retrospective comparison of treatment outcome in patients with MDR-TB who completed treatment with a bedaquiline-containing treatment regimen (Bdq cohort) and a matched cohort of patients with MDR-TB treated without bedaquiline (non-Bdq cohort). <b>Results:</b> Patients from the Bdq cohort (n = 75) had a higher frequency of fluoroquinolone resistance and cavitary disease than patients from the non-BDQ cohort (n = 75). The rate of sputum smear conversion at 24 weeks of treatment (72.0% vs 54.7%, p = 0.03) was higher and the median time to sputum culture conversion was lower (8 weeks vs 16 weeks, p = 0.02) in the Bdq cohort than in the non-Bdq cohort. The differences observed between Bdq and nonBdq cohorts in rates of cure and death were statistically nonsignificant. (62.7% vs 48.0%, p = 0.1 and 9.3% vs 14.7%, p = 0.3, correspondingly). More than 40% of patients previously failing MDR-TB treatments achieved cure with Bdq-containing treatments. The independent factors associated with cure from MDR-TB were use of bedaquiline in the treatment regimen (OR 4.9, 95%CI 1.5 - 17.6) and fluoroquinolone susceptibility of the mycobacterium strain (OR 3.1, 95%CI 1.3 - 7.8). <b>Conclusions:</b> Bedaquiline based MDR-TB treatment regimens result in faster disease resolution and at least similar treatment outcomes, when compared to bedaquiline sparing MDR-TB treatment regimens under programmatic conditions in an Eastern European country with a high-burden of MDR-TB.