Cheraghi Mahdis, Amiri Mehrnaz, Andarzgoo Sahar, Zarei Fatemeh, Seghatoleslami Zahra Sadat, Centis Rosella, Visca Dina, D'Ambrosio Lia, Pontali Emanuele, Nasiri Mohammad Javad, Migliori Giovanni Battista
. School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
. Faculty of Nursing and Midwifery, Islamic Azad University, Tehran, Iran.
J Bras Pneumol. 2025 Mar 31;51(1):e20240391. doi: 10.36416/1806-3756/e20240391. eCollection 2025.
Multidrug-resistant tuberculosis (MDR-TB) remains a global public health challenge, complicating treatment strategies and requiring advanced therapeutic approaches. The persistence of MDR-TB has led to a demand for regimens that are more effective in improving treatment outcomes and controlling transmission. This systematic review and meta-analysis sought to examine the efficacy of linezolid (LZD) and bedaquiline (BDQ) in MDR-TB treatment regimens, evaluating their roles in enhancing therapeutic success and informing optimized management of MDR-TB.
A comprehensive search was conducted across MEDLINE (PubMed), EMBASE, the Cochrane Central Register of Controlled Trials, Scopus, and Web of Science for randomized controlled trials assessing the efficacy of LZD and BDQ in MDR-TB patients up to September 14, 2024. We analyzed treatment outcomes, reporting favorable outcomes (cured and treatment completed) and unfavorable outcomes (death, treatment failure, and loss to follow-up) with a 95% confidence interval.
Our analysis included 11 trials, with a total of 1,999 participants. The findings indicate that BDQ+LZD-containing regimens yield significantly higher favorable treatment outcomes (84.5%; 95% CI, 79.8%-88.2%) and lower unfavorable outcomes (15.4%; 95% CI, 11.6%-20.2%). In contrast, regimens lacking either LZD or BDQ show lower efficacy, with favorable outcomes at 66.8% (95% CI, 59.5%-73.4%) and unfavorable outcomes at 33.0% (95% CI, 25.6%-41.4%).
MDR-TB treatment regimens including BDQ and LZD lead to significantly better patient outcomes. The combined bactericidal and protein synthesis-inhibiting effects of BDQ and LZD create a powerful therapeutic synergy. Adding pretomanid further enhances this effectiveness, highlighting its value in complex cases. Future research should focus on optimizing these regimens for safety and efficacy and explore adjunctive therapies to improve MDR-TB outcomes even further.
耐多药结核病（MDR-TB）仍然是一项全球公共卫生挑战，使治疗策略复杂化，需要先进的治疗方法。MDR-TB的持续存在导致人们对更有效地改善治疗结果和控制传播的治疗方案有需求。本系统评价和荟萃分析旨在研究利奈唑胺（LZD）和贝达喹啉（BDQ）在MDR-TB治疗方案中的疗效，评估它们在提高治疗成功率和为MDR-TB的优化管理提供信息方面的作用。
在MEDLINE（PubMed）、EMBASE、Cochrane对照试验中央注册库、Scopus和Web of Science上进行全面检索，以查找截至2024年9月14日评估LZD和BDQ对MDR-TB患者疗效的随机对照试验。我们分析了治疗结果，报告了有利结果（治愈和完成治疗）和不利结果（死亡、治疗失败和失访），并给出95%置信区间。
我们的分析纳入了11项试验，共1999名参与者。研究结果表明，含BDQ+LZD的治疗方案产生显著更高的有利治疗结果（84.5%；95%CI，79.8%-88.2%）和更低的不利结果（15.4%；95%CI，11.6%-20.2%）。相比之下，不含LZD或BDQ的治疗方案疗效较低，有利结果为66.8%（95%CI，59.5%-73.4%），不利结果为33.0%（95%CI，25.6%-41.4%）。
包括BDQ和LZD的MDR-TB治疗方案可显著改善患者预后。BDQ和LZD联合的杀菌和抑制蛋白质合成作用产生强大的治疗协同效应。添加pretomanid可进一步提高这种有效性，突出了其在复杂病例中的价值。未来的研究应侧重于优化这些方案的安全性和疗效，并探索辅助疗法以进一步改善MDR-TB的治疗结果。
