Relapse and Emergent Resistance With Novel Short-Course Regimens for Multidrug-Resistant Tuberculosis, United States,...

Area of Science:

• Infectious Diseases
• Public Health
• Clinical Medicine

Background:

• Bedaquiline, pretomanid, and linezolid with or without moxifloxacin (BPaL/M) are recommended oral 6-month treatment regimens for multidrug- or rifampin-resistant (MDR/RR) tuberculosis (TB).
• Since their US rollout in 2019, adverse outcomes including treatment failure and relapse have been identified in patients receiving these regimens.

Purpose of the Study:

• To report a case series of US patients with TB treated with BPaL/M-containing regimens.
• To describe adverse outcomes such as drug resistance, relapse, and treatment failure in a real-world setting.

Main Methods:

• A case series of US patients with TB treated with BPaL/M regimens between 2022-2024 was analyzed.
• Clinical and public health outcomes were documented for identified patients.

Main Results:

• Eight patients experienced adverse outcomes, including relapse, treatment failure, and acquired drug resistance.
• Significant public health implications were observed, including transmission events and patient mortality.
• Case examples include a patient who died from infectious TB with acquired resistance, a waitress with infectious relapse, and a household transmission event.

Conclusions:

• Real-world data reveal significant consequences of relapse and treatment failure with BPaL/M regimens.
• Challenges persist for US clinicians in managing drug-resistant TB despite newer regimens.
• Expert management, close monitoring, and follow-up are crucial for patients with drug-resistant TB post-treatment.