Delamanid-containing regimens and multidrug-resistant tuberculosis: A systematic review and meta-analysis. (November 2022)

• Record Type: Journal Article
• Authors: Nasiri, Mohammad Javad; Zangiabadian, Moein; Arabpour, Erfan; Amini, Sirus; Khalili, Farima; Centis, Rosella; D'Ambrosio, Lia; Denholm, Justin T.; Schaaf, H. Simon; van den Boom, Martin; Kurhasani, Xhevat; Dalcolmo, Margareth Pretti; Al-Abri, Seif; Chakaya, Jeremiah; Alffenaar, Jan-Willem; Akkerman, Onno; Silva, Denise Rossato; Muňoz-Torrico, Marcela; Seaworth, Barbara; Pontali, Emanuele; Saderi, Laura; Tiberi, Simon; Zumla, Alimuddin; Migliori, Giovanni Battista; Sotgiu, Giovanni
• Is Part Of: International journal of infectious diseases. Volume 124(2022)Supplement 1
• Page Start: S90
• Page End: S103
• Publication Date: 2022-11
• Subjects: TB -- MDR-TB -- delamanid -- bedaquiline -- effectiveness -- safety; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2022.02.043
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: MDR-TB is difficult to manage; updated clinical guidance of new drug use is needed No recent systematic review/meta-analysis on delamanid (DLM) is available In observational studies including DLM (591 patients) the success rate was 80.9% In experimental studies including DLM (391 patients) the success rate was 72.5% Few adverse events attributable to DLM were reported Abstract: Introduction: Multidrug-resistant tuberculosis (MDR-TB) is a life-threatening condition needing long poly-chemotherapy regimens. As no systematic reviews/meta-analysis is available to comprehensively evaluate the role of delamanid (DLM), we evaluated its effectiveness and safety. Methods: We reviewed the relevant scientific literature published up to January 20, 2022. The pooled success treatment rate with 95% confidence intervals (CI) was assessed using a random-effect model. We assessed studies for quality and bias, and considered P<0.05 to be statistically significant. Results: After reviewing 626 records, we identified 25 studies that met the inclusion criteria, 22 observational and 3 experimental, with 1276 and 411 patients, respectively. In observational studies the overall pooled treatment success rate of DLM-containing regimens was 80.9% (95% CI 72.6-87.2) with no evidence of publication bias (Begg's test; P >0.05). The overall pooled treatment success rate in DLM and bedaquiline-containing regimens was 75.2% (95% CI 68.1-81.1) with no evidence of publication bias (Begg's test; P >0.05). In experimental studies the pooled treatment success rate of DLM-containing regimens was 72.5 (95% CI 44.2-89.8, P <0.001, I 2 : 95.1%) with no evidence of publication bias (Begg's test; P >0.05). Conclusions: In MDR-TB patients receiving DLM, culture conversion and treatment success rates were high despite extensive resistance with limited adverse events.