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Safe, effective treatment options are urgently needed for those with tuberculosis caused by drug-resistant Mycobacterium tuberculosis. In a recent study in South Africa, the combination of bedaquiline, pretomanid, and linezolid (1200 mg linezolid daily; BPL 1200) for 26 weeks yielded a microbiologic cure rate over 90%, but with significant linezolid toxicity (NEJM JW Infect Dis May 2020 and N Engl J Med 2020 Mar 5; 382:893). Now, these investigators have assessed the efficacy and toxicity of four different 26-week regimens for highly drug-resistant pulmonary tuberculosis in which linezolid was given at 1200 mg daily for 9 weeks (BPL 1200-9) or 26 weeks (BPL 1200-26), or at 600 mg daily for 9 weeks (BPL 600-9) or 26 weeks (BPL 600-26).
Among 181 enrollees, 36 (20%) were HIV positive. In a modified intention-to-treat analysis, rates of clinical cure without relapse at 26 weeks after treatment completion were 93% (BPL 1200-26), 89% (BPL 1200-9), 91% (BPL 600-26), and 84% (BPL 600-9). HIV positivity did not affect the outcome. At least one adverse event occurred or worsened in 86% of participants. Peripheral neuropathy occurred in 38%, 24%, 24%, and 13% of patients who received BPL 1200-26, BPL 1200-9, BPL 600-26, and BPL 600-9, and myelosuppression occurred in 22%, 15%, 2%, and 7% of recipients, respectively.
Créditos: Comité científico Covid