Effectiveness and Safety of Bedaquiline-Containing Modified Shorter Regimens for Multidrug- or Rifampicin-Resistant...

Area of Science:

• Infectious Diseases
• Public Health
• Pharmacology

Background:

• Tuberculosis (TB) remains a global health crisis, with multidrug-resistant (MDR-TB) and rifampicin-resistant TB (RR-TB) presenting significant treatment challenges.
• Conventional TB regimens are often lengthy, toxic, and poorly tolerated, necessitating the development of improved treatment options.

Purpose of the Study:

• To systematically evaluate the effectiveness and safety of modified shorter regimens containing bedaquiline for patients with MDR/RR-TB.
• To assess adaptations of the WHO-recommended 9-12-month bedaquiline-containing shorter regimen, including substitutions with linezolid, cycloserine/terizidone, and/or delamanid.

Main Methods:

• A systematic literature search was conducted across major databases (PubMed, Cochrane Library, Embase, Web of Science) up to December 17, 2025.
• Eleven studies involving 8166 patients were included, with data extracted on treatment success rates and adverse events.
• Statistical heterogeneity was assessed using the Cochrane Q test and I² statistic.

Main Results:

• The pooled treatment success rate for bedaquiline-containing modified shorter regimens was 78.5% (95% CI: 0.69-0.87).
• The incidence of serious adverse events was reported at 10.0%.
• These modified regimens demonstrated a potentially viable treatment option, especially for patients ineligible for standardized treatments.

Conclusions:

• Bedaquiline-containing modified shorter regimens represent a promising alternative for managing MDR/RR-TB.
• These regimens may enhance treatment options for patients with limited alternatives.
• Further large-scale clinical trials are warranted to validate these findings.