Impact of bedaquiline resistance probability on treatment decision for rifampicin-resistant TB
BACKGROUND: Accurate diagnosis of bedaquiline (BDQ) resistance remains challenging. A Bayesian approach expresses this uncertainty as a probability of BDQ resistance (prBDQR) with a 95% credible interval. We investigated how prBDQ R information influences BDQ prescribing decisions. METHOD: We perfor...
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International Union Against Tuberculosis and Lung Disease (The Union)
2024-09-01
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| Series: | IJTLD Open |
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| author | T.P.H. Trang R. Kessels T. Decroo A. Van Rie |
| author_facet | T.P.H. Trang R. Kessels T. Decroo A. Van Rie |
| author_sort | T.P.H. Trang |
| collection | DOAJ |
| description | BACKGROUND: Accurate diagnosis of bedaquiline (BDQ) resistance remains challenging. A Bayesian approach expresses this uncertainty as a probability of BDQ resistance (prBDQR) with a 95% credible interval. We investigated how prBDQ R information influences BDQ prescribing decisions. METHOD: We performed a discrete choice experiment with 55 international rifampicin-resistant tuberculosis physicians. We employed mixed-effects multinomial logistic regression to quantify the effect of prBDQR, patient attributes, and contextual factors on the decision to continue BDQ or not when sequencing results become available. RESULTS: PrBDQ R was the most influential factor for BDQ decision-making, three times greater than treatment response. Each percentage point increase in prBDQ R resulted in 8.2% lower odds (OR 0.92, 95% CI 0.90–0.93) of continuing BDQ as a fully effective drug and 5.0% lower odds (OR 0.95, 95% CI 0.94–0.96) of continuing it but not counting it as an effective drug. The most favourable patient profile for prescribing BDQ as a fully effective drug was a patient receiving the BPaLM regimen (BDQ, pretomanid, linezolid and moxifloxacin) with low prBDQ R , good 1-month treatment response, fluoroquinolone-susceptible TB, and no prior BDQ treatment. Physicians with higher discomfort with uncertainty and more years of experience with BDQ were more inclined to stop BDQ. CONCLUSION: Given the uncertainty of genotype-phenotype associations, physicians valued prBDQ R for BDQ decision-making in rifampicin-resistant TB treatment. |
| format | Article |
| id | doaj-art-462febafbb1c426ab4f22a304fbd6634 |
| institution | Kabale University |
| issn | 3005-7590 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | International Union Against Tuberculosis and Lung Disease (The Union) |
| record_format | Article |
| series | IJTLD Open |
| spelling | doaj-art-462febafbb1c426ab4f22a304fbd66342025-01-22T12:16:08ZengInternational Union Against Tuberculosis and Lung Disease (The Union)IJTLD Open3005-75902024-09-011938439010.5588/ijtldopen.24.03622Impact of bedaquiline resistance probability on treatment decision for rifampicin-resistant TBT.P.H. Trang0R. Kessels1T. Decroo2A. Van Rie3Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium;Department of Data Analytics and Digitalization, Maastricht University, Maastricht, The Netherlands;Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium;BACKGROUND: Accurate diagnosis of bedaquiline (BDQ) resistance remains challenging. A Bayesian approach expresses this uncertainty as a probability of BDQ resistance (prBDQR) with a 95% credible interval. We investigated how prBDQ R information influences BDQ prescribing decisions. METHOD: We performed a discrete choice experiment with 55 international rifampicin-resistant tuberculosis physicians. We employed mixed-effects multinomial logistic regression to quantify the effect of prBDQR, patient attributes, and contextual factors on the decision to continue BDQ or not when sequencing results become available. RESULTS: PrBDQ R was the most influential factor for BDQ decision-making, three times greater than treatment response. Each percentage point increase in prBDQ R resulted in 8.2% lower odds (OR 0.92, 95% CI 0.90–0.93) of continuing BDQ as a fully effective drug and 5.0% lower odds (OR 0.95, 95% CI 0.94–0.96) of continuing it but not counting it as an effective drug. The most favourable patient profile for prescribing BDQ as a fully effective drug was a patient receiving the BPaLM regimen (BDQ, pretomanid, linezolid and moxifloxacin) with low prBDQ R , good 1-month treatment response, fluoroquinolone-susceptible TB, and no prior BDQ treatment. Physicians with higher discomfort with uncertainty and more years of experience with BDQ were more inclined to stop BDQ. CONCLUSION: Given the uncertainty of genotype-phenotype associations, physicians valued prBDQ R for BDQ decision-making in rifampicin-resistant TB treatment.https://www.ingentaconnect.com/contentone/iuatld/ijtldo/2024/00000001/00000009/art00002discrete choice experimentclinical decision-makingtreatment uncertainty |
| spellingShingle | T.P.H. Trang R. Kessels T. Decroo A. Van Rie Impact of bedaquiline resistance probability on treatment decision for rifampicin-resistant TB IJTLD Open discrete choice experiment clinical decision-making treatment uncertainty |
| title | Impact of bedaquiline resistance probability on treatment decision for rifampicin-resistant TB |
| title_full | Impact of bedaquiline resistance probability on treatment decision for rifampicin-resistant TB |
| title_fullStr | Impact of bedaquiline resistance probability on treatment decision for rifampicin-resistant TB |
| title_full_unstemmed | Impact of bedaquiline resistance probability on treatment decision for rifampicin-resistant TB |
| title_short | Impact of bedaquiline resistance probability on treatment decision for rifampicin-resistant TB |
| title_sort | impact of bedaquiline resistance probability on treatment decision for rifampicin resistant tb |
| topic | discrete choice experiment clinical decision-making treatment uncertainty |
| url | https://www.ingentaconnect.com/contentone/iuatld/ijtldo/2024/00000001/00000009/art00002 |
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