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Bedaquiline-Pretomanid-Linezolid Regimens Compared for XDR TB

Last Updated: September 16, 2022.

FRIDAY, Sept. 16, 2022 (HealthDay News) -- For patients with extensively drug-resistant (XDR) tuberculosis, the overall risk-benefit ratio seems to favor patients receiving the bedaquiline-pretomanid-linezolid regimen with linezolid at a dose of 600 mg for 26 weeks, according to a study published in the Sept. 1 issue of the New England Journal of Medicine.

Francesca Conradie, M.B., B.Ch., from the University of the Witwatersrand in Johannesburg, South Africa, and colleagues enrolled participants with XDR tuberculosis, pre-XDR tuberculosis, or rifampicin-resistant tuberculosis that was not responsive to treatment or for which a second-line regimen had been discontinued due to side effects. Participants were randomly assigned to receive bedaquiline for 26 weeks, pretomanid, and daily linezolid at a dose of 1,200 mg for 26 weeks or nine weeks or 600 mg for 26 weeks or nine weeks. One hundred eighty-one participants were enrolled.

The researchers found a favorable outcome for 93, 89, 91, and 84 percent of those receiving bedaquiline-pretomanid-linezolid with linezolid at a dose of 1,200 mg for 26 weeks or nine weeks or 600 mg for 26 weeks or nine weeks, respectively; peripheral neuropathy occurred in 38, 24, 24, and 13 percent, respectively; and myelosuppression occurred in 22, 15, 2, and 7 percent, respectively. In 51, 30, 13, and 13 percent of participants, the linezolid dose was modified (i.e., interrupted, reduced, or discontinued). In four participants (9 percent) who had received linezolid at a dose of 1,200 mg for 26 weeks, optic neuropathy developed.

"A 600-mg, 26-week regimen of linezolid appeared to have the most favorable risk-benefit profile among the regimens studied," the authors write.

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