A regimen containing bedaquiline and delamanid compared to bedaquiline in patients with drug-resistant tuberculosis

There are limited data on combining delamanid and bedaquiline in drug-resistant tuberculosis (DR-TB) regimens. Prospective long-term outcome data, including in HIV-infected persons, are unavailable.We prospectively followed up 122 South African patients (52.5% HIV-infected) with DR-TB and poor prognostic features between 2014 and 2018. We examined outcomes and safety in those who received a bedaquiline-based regimen (n=82) compared to those who received a bedaquiline-delamanid combination regimen (n=40).There was no significant difference in 6-month culture conversion (92.5% 81.8%; p=0.26) and 18-month favourable outcome rate (63.4% 67.5%; p=0.66) in the bedaquiline the bedaquiline-delamanid combination group, despite the latter having more advanced drug resistance (3.7% 22.5% resistant to at least five drugs; p=0.001) and higher pre-treatment failure rates (12.2% 52.5% with pre-treatment multidrug-resistant TB therapy failure; p