Bedaquiline and clofazimine : successes and challenges

Abstract

Bedaquiline, a novel therapeutic drug, and clofazimine, a re-purposed drug, are front-line therapies recommended by WHO to treat rifampicin-resistant or multidrugresistant tuberculosis. Both drugs have been in use in South Africa at least 10 years: bedaquiline since 2007 and clofazimine since 2010. The use of bedaquiline in programmatic settings in South Africa has reduced the risk of all-cause mortality threefold (hazard ratio 0·35, 95% CI 0·28–0·46)1 and achieved treatment success in at least 70% of patients.2 The inclusion of clofazimine in combination therapy has reduced treatment duration from 18–24 months to 9–12 months. South Africa has adopted both drugs extensively in the modified short and long regimens for rifampicin-resistant or multidrug-resistant tuberculosis. According to the electronic drug-resistant tuberculosis register, as of June 1, 2020, 29 193 individuals in South Africa have received bedaquiline, and 30 599 have received clofazimine. Emerging resistance and cross-resistance have been reported.