Summary

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• This summary is based on the review of 26 systematic review(s)/meta-analysis(es). ^[1-26]
• Sputum Culture Conversion Rates: Benefits of bedaquiline (BDQ)-containing regimens significantly improved sputum culture conversion rates at 8-12 weeks (relative risk (RR) = 1.35, 95% confidence interval (CI): 1.10-1.65) and 24-26 weeks (RR = 1.25, 95% CI: 1.15-1.36). BDQ also showed superior conversion rates in follow-up phases for both RCTs and NRSs (RR = 1.53, 95% CI: 1.07-2.20).
• Treatment Success Rates: Higher treatment success rates were observed with BDQ-containing regimens in RCTs (RR = 1.30, 95% CI: 1.17-1.44). Observational and experimental studies reported pooled success rates of 76.9% (95% CI, 72.9-80.4) and 81.7% (95% CI, 67.2-90.7), respectively.
• Time to Culture Conversion: BDQ reduced the time to culture conversion by an average of 17 days (standardized mean difference (SMD)) = -17.46, 95% CI: -34.82 to -0.11).
• Relapse Rates: BDQ-containing all-oral regimens showed a pooled relapse rate of 2.0% (95% CI, 1.0-3.0%).
• No significant reduction in all-cause mortality (RR [95% CI] = 0.94 [0.41-2.20]) or serious adverse events (RR [95% CI] = 0.91 [0.67-1.23]) was observed in the BDQ-regimen group compared to non-BDQ regimens.
• BDQ-containing regimens were associated with a higher incidence of cardiotoxicity (RR = 4.54, 95% CI: 1.74 to 11.87 in RCTs; RR = 6.00, 95% CI: 1.32 to 27.19 in NRSs) and increased incidence of grade 3-5 adverse events (RR = 1.42, 95% CI: 1.17 to 1.73 in RCTs).
• The pooled proportion of QTc prolongation in BDQ regimens was 7.8% (95% CI: 4.1-11.6%).
• Use of BDQ and Linezolid-based regimens improved treatment outcomes and reduced mortality in HIV-positive patients, with higher treatment success rates correlated to elevated baseline CD4 T-cell counts; BDQ also showed improved treatment outcomes across income levels and better success rates in high-income countries compared to upper-middle-income countries, with effectiveness further supported in specific populations based on age, sex, geographic site, previous TB treatment, and against Mycobacterium abscessus and M. avium complex.