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Bedaquiline reloading strategies following interruptions during daily dosing
Nienke Kikstra1,2, Stijn W van Beek3, Gary Maartens4,5
1Department of Pharmacy, Pharmacology and Toxicology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
Abstract:
Once-daily bedaquiline therapy is a WHO-listed alternative to thrice-weekly dosing for rifampicin-resistant tuberculosis, but, contrary to the thrice-weekly schedule, no guidance exists for treatment re-initiation after interruption. Using a population pharmacokinetic model, we simulated bedaquiline and M2 exposure under various interruption and reloading scenarios. Reloading strategies tailored to interruption duration restored bedaquiline exposure without clinically relevant increases in M2 peak concentrations, providing practical guidance for safe and effective treatment resumption of once-daily bedaquiline therapy.
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