A retrospective cohort analysis of bedaquiline resistance in patients with Rifampicin Resistant TB with or without second line drug resistance, Karakalpakstan (2015-2020)

Principal investigator

Parvati Nair
Purpose of study
Purpose of study

The study will evaluate the risk factors associated with amplification of resistance in patients with RR-TB and on new drugs within a long running large comprehensive TB programme.

  • Concept
  • Protocol & ERB
  • Implementation
  • Completion
  • Archived

Study timeline

  • Talk or presentation dissemination added by Animesh Sinha

    8th November 2022

    Union Conference OA08-257-08 Emergence of resistance to bedaquiline in Karakalpakstan, Uzbekistan
    S. Moe,1 M. Rekart,1 A. Bayniyazova,1 M. Oluya,2 S. Allamuratova,3 T. Zinaida,4 C. Gomez,5 N. Sitali,6 A. Sinha,7
    1Medecins Sans Frontieres, Medical, Nukus, Uzbekistan, 2Medecins Sans Frontieres, Laboratory, Nukus, Uzbekistan, 3Medecins Sans Frontieres, Epidemiology, Nukus, Uzbekistan, 4Republican Tuberculosis Hospital No.2, Medical, Nukus, Uzbekistan, 5Medecins Sans Frontieres, Medical, Tashkent, Uzbekistan, 6Medecins Sans Frontieres, Medical, Berlin, Germany, 7Medecins Sans Frontieres, Manson Unit, London, United Kingdom of Great Britain and Northern Ireland

    We present data on 64 MDR-TB patients from Karakalpakstan, Uzbekistan, with bedaquiline resistance. This is an emerging challenge that puts current treatment regimens at risk. Close monitoring of patients with risk factors for the emergence of resistance and individualised treatment regimens are required for better treatment outcomes.

    BACKGROUND: WHO recommends the use of bedaquiline (Bdq) in longer as well as shorter multidrug-resistant tuberculosis (MDR-TB) treatment regimens. However, resistance to this new drug is now emerging. A recent systematic review found relevant frequency of acquired bedaquiline resistance in patients on bdq containing regimens (Mallick J. et. al.). There are no standardized regimens and limited treatment options for patients with resistance to bedaquiline. We aim to describe the characteristics and share our experience from management of patients with MDR-TB with resistance to Bdq.
    DESIGN/METHODS: We performed a retrospective study of routinely collected data for patients treated for MDR-TB in Karakalpakstan between January 2015 and March 2022. We included 64 patients with confirmed bedaquiline resistance on phenotypic drug susceptibility testing (DST) at any point before, during or after TB treatment. We describe the baseline characteristics, treatment, and follow-up of these patients while on TB treatment.
    RESULTS: Twelve (18.8%) patients showed primary Bdq-resistance, seventeen (26.6%) patients acquired resistance during treatment and thirty-five (54.7%) patients had no baseline DST or exposure history to bedaquiline. There were forty-three male patients representing 67.2% of the total cohort. The treatment regimens for these patients included clofazimine (93%), linezolid (84%), delamanid (79%), cycloserine (63%), and bedaquiline (53%). The interim clinical outcome for the 43 patients whose treatment history were available are; twenty-one (48.8%) on treatment, seven (16.3%) treatment completed or cured, six (14%) treatment failure, five (11.6%) died, and four (9.3%) lost to follow-up.
    CONCLUSIONS: Our programmatic data gives an overview of the emergence of resistance to Bdq in a TB programme using bedaquiline for management of MDR-TB. Primary resistance to bedaquiline was present in almost a fifth of patients, highlighting the need for baseline DST to Bdq. Follow-up DST should be performed for patients on Bdq containing regimens who fail to culture convert.

  • Conference abstract added by Animesh Sinha

    8th November 2022
    7.36 MB
  • Publication added by Animesh Sinha

    1st July 2022
    Acquired bedaquiline resistance in Karakalpakstan, Uzbekistan Nair, P. – International Union Against Tuberculosis and Lung Disease (2022)


  • Acquired bedaquiline resistance in Karakalpakstan, Uzbekistan
    Nair, P. "–" International Union Against Tuberculosis and Lung Disease "(2022)"