Drug-resistant tuberculosis treatment

end of treatment (e.g. pre-existing comorbidities require that both bedaquiline and linezolid 
be stopped early because of health risks), then starting with five effective agents rather than 
four may be advisable. These provisions are expected to apply to most MDR-TB patients, including 
those with additional resistance to fluoroquinolones or other
medicines.
Regarding PICO question 8 (MDR/RR-TB, 2020) (use of bedaquiline longer than 6 months), the 
analysis yielded adjusted odds ratios of 1.5 (95% CI: 0.7–2.7) for treatment success versus failure, 0.8 
(95% CI: 0.2–0.4) for treatment success versus death, 1.0 (95% CI: 0.5–1.7) for treatment success versus 
failure or death, and 0.8 (95% CI: 0.5–1.2) for treatment success versus all unfavourable outcomes. 
The evidence reviewers had planned to use two analytical approaches designed to minimize bias; 
that is, marginal structural models to account for time-varying confounders, and exact and propensity 
score matching of patient characteristics. However, sample size meant that there were limitations in 
how the first approach could be applied; also, owing to limitations with the dataset, biostatisticians 
advised that it was not possible to adjust for confounders according to the original data analysis plan. 
The GDG noted that the population included in the studies that were assessed comprised a highly 
selected population, with the potential for confounding by indication (i.e. the people who received 
bedaquiline for >6 months were likely to have done so because of clinical factors that indicated 
prolonged treatment with bedaquiline). The GDG concluded that there was a high likelihood of residual 
confounding in the data, and that the patient population addressed in the study did not permit 
extrapolation to routine use in all MDR/RR-TB patients. This precluded a formal recommendation 
on the efficacy or effectiveness of bedaquiline use beyond 6 months duration; however, the GDG 
concluded that a statement on safety could be made. This information is included in