Comparative Analysis of Treatment Outcomes in Drug-Resistant Tuberculosis Patients with and without Bedaquiline in Pakistan: A Retrospective Cohort Study

Background: Multidrug-resistant tuberculosis (MDR-TB) poses a significant threat to global TB control, with new drugs such as bedaquiline being introduced to improve treatment outcomes.This study aimed to compare the treatment outcomes of drug-resistant TB (DR-TB) patients treated with and without bedaquiline.Methods: We conducted a retrospective cohort analysis of 450 patients registered in Pakistan's rifampicin-resistant tuberculosis case registry (ENRS) between January 1, 2015, and December 31, 2022.Of these, 32 patients received bedaquiline, while 418 did not.Key demographic and clinical characteristics were compared between groups.Kaplan-Meier survival analysis was performed to assess survival probabilities.The primary outcomes were treatment success, failure, loss to follow-up (LTFU), and mortality.Results: No significant difference in overall treatment success was observed between patients treated with bedaquiline (81.3%) and those without bedaquiline (78.9%) (p=0.75).Both groups had a high cure rate, with 75.0% of bedaquiline-treated patients and 74.6% of non-bedaquiline patients achieving a cure (p=0.85).However, no treatment failures were recorded in the bedaquiline group, compared to a 4.8% failure rate in the non-bedaquiline group.Kaplan-Meier survival analysis revealed similar survival probabilities between MDR-TB and rifampicin-resistant TB patients, irrespective of bedaquiline use.Urban residence was significantly associated with bedaquiline use (p=0.007),suggesting better access to newer treatments in urban areas.Conclusion: Although bedaquiline did not significantly alter overall treatment outcomes in this cohort, its use appears to prevent treatment failure, particularly in complex DR-TB cases.Sociodemographic factors, such as urban residence, are critical in determining bedaquiline access.Equitable access to advanced TB therapies and optimizing bedaquiline use in combination regimens remain essential for improving MDR-TB treatment outcomes.Further research is needed to explore the long-term impact of bedaquiline in diverse populations.