DOI: https://doi.org/10.14710/dimj.v1i7.30994

EFFECTS OF THE BPAL REGIMEN ON HEMATOLOGICAL PARAMETERS IN PATIENTS WITH MULTIDRUG-RESISTANT TUBERCULOSIS

*Dwi Retnoningrum orcid  -  Department of Clinical Pathology, Faculty of Medicine, Universitas Diponegoro, Indonesia
Sustika Novianita Assan  -  Clinical Pathology Residency Program, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia, Indonesia
Villa Sekar Cita orcid  -  Department of Clinical Pathology, Faculty of Medicine, Universitas Diponegoro, Indonesia
Ardhea Jaludamascena orcid  -  Department of Clinical Pathology, Dr. Kariadi Hospital, Semarang, Indonesia, Indonesia

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Abstract

Background: BPaL is a new oral drug combination consisting of Bedaquiline (B), Pretomanid (Pa) and Linezolid (L) for multi-drug resistance tuberculosis. In Indonesia BPaL has been officially launched by the government as a therapeutic regimen for multidrug resistant tuberculosis patients since August 2023. One of the drugs in this regimen has the side effect of anemia. Until now, there are still no references explaining the effect of BPaL on the hematological profile.

Objective: To determine the differences in the hematological profile of multidrug resistance tuberculosis patients before receiving the multi drug resistance regimen BPaL anti-tuberculosis drug regimen and while receiving the multi drug resistance regimen BPaL anti-tuberculosis drug regimen.

Methods: This research was a retrospective observational analytical study with a retrospective cohort design involving patients with multidrug-resistant tuberculosis in Kariadi Hospital based on medical records. The difference test used the paired T-test and the Wilcoxon test.

Results: 40 subjects were recruited, there were significant differences in hemoglobin level (p=0.003), hematocrit (p=0.002), red blood cells count (p=<0.001), white blood cells count (p=0.004), platelet count (p=<0.001) and RDW (p=<0.001) before therapy with the BPaL regimen and during therapy with the BPaL regimen.

Conclusion: There are significant differences in the hematological profile of multidrug resistant patients, before treatment with the BPaL regimen and while receiving the BPaL regimen.

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Keywords: Tuberculosis, BPaL, multidrug resistant, hematology

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Section: Original Research Article
Language : EN
  1. Kassa E, Enawgaw B, Gelaw A, Gelaw B. Effect of anti-tuberculosis drugs on hematological profiles of tuberculosis patients attending at University of Gondar Hospital, Northwest Ethiopia. BMC Hematol. 2016;16:1
  2. P2P Kemenkes RI. Laporan Program Penanggulangan Tuberkulosis Tahun 2022. Jakarta: Kementerian Kesehatan RI; 2022. 156 p
  3. Putra P. Effect of Anti-Tuberculosis Multi Drug Resistance Regimen on Hematological Lung Tuberculosis Patients Profile with Multi Drug Resistance. Berk Kedokt. 2018 Mar 1;14:59
  4. Network TT& H investigative. Programmatic Introduction of the BPaL Regimen: A Practical Implementation Guide. THINK International; 2021. 95 p
  5. Pratt M, McNicol M, Hunter M, Dedicoat M. First use of Bedaquiline, Linezolid, and Pretomanid (BPaL) in a family cluster of multi-drug resistant (MDR) TB infection. Ulster Med J. 2024 Dec;93(2):55-57. Epub 2024 Dec 11. PMID: 39669953; PMCID: PMC11633317
  6. Haley CA, Schechter MC, Ashkin D, et al. Implementation of Bedaquiline, Pretomanid, and Linezolid in the United States: Experience Using a Novel All-Oral Treatment Regimen for Treatment of Rifampin-Resistant or Rifampin-Intolerant Tuberculosis Disease. Clin Infect Dis. 2023;77(7):1053-1062. doi: 10.1093/cid/ciad312
  7. van de Berg SEJ, Pelzer PT, van der Land AJ, Abdrakhmanova E, Ozi AM, Arias M, et al. Acceptability, feasibility, and likelihood of stakeholders implementing the novel BPaL regimen to treat extensively drug-resistant tuberculosis patients. BMC Public Health. 2021 Jul;21(1):1404
  8. Departement of Health Republic of South Africa. Introduction of BPaL-L, a 6-month RR-TB regimen. Knowledgehub; 2022. 1–10 p
  9. NHS England. BPaLM / BPaL for patients aged ≥ 14 years with suspected , functional or confirmed rifampicin resistant ( RR ) tuberculosis ( TB ), multidrug-resistant ( MDR ) TB or pre-extensively drug resistant ( pre-XDR ) TB [ URN : 2310 ] Plain language summary. NHS England; 2024
  10. Putra O, Faizah A, D.N N. Six Months of Bedaquiline-Pretomanid-Linezolid (BPaL) Regimen in Patients with Drug-Resistant Tuberculosis: A Narrative Review. J Endocrinol Trop Med Infect Dis. 2023 Jul 8;5:83–95
  11. WHO. Module 4: Drug-resistant tuberculosis treatment. In: WHO consolidated guidelines on tuberculosis. WHO Press; 2022. p. 98
  12. Wijasa WN, Suyatno D, Barliana MI, Pradipta IS. Efikasi, Keamanan, Efisiensi Biaya Penggunaan Rejimen Bedaquilin, Pretomanid, dan Linezolid (BPaL) dalam Pengobatan Tuberkulosis REsisten Obat Ganda. Maj Farm dan Farmakol. 2023;27(3):76–81
  13. Conradie F, Bagdasaryan TR, Borisov S, Howell P, Mikiashvili L, Ngubane N, et al. Bedaquiline-Pretomanid-Linezolid Regimens for Drug-Resistant Tuberculosis. N Engl J Med. 2022 Sep;387(9):810–23
  14. Oehadian A, Santoso P, Menzies D, Ruslami R. Hematologic Toxicity of Linezolid in Multidrug Resistant and Extensively Drug Resistant Tuberculosis (MDR/XDR-TB): the role of mitochondria. Tuberc Respir Dis (Seoul). 2022 Jan 20;85
  15. CDC. Updates to Provisional Guidance for the Use of Pretomanid as Part of a Regimen [Bedaquiline, Pretomanid, and Linezolid (BPaL)] to Treat Drug-Resistant Tuberculosis Disease. 2022
  16. Imperial MZ, Nedelman JR, Conradie F, Savic RM. Proposed Linezolid Dosing Strategies to Minimize Adverse Events for Treatment of Extensively Drug-Resistant Tuberculosis. Clin Infect Dis. 2022 May 30;74(10):1736-1747. doi: 10.1093/cid/ciab699.PMID:34604901;PMCID:PMC9155613
  17. Hasan T, Medcalf E, Nyang'wa BT, Egizi E, Berry C, Dodd M, et al. The safety and tolerability of linezolid in novel short-course regimens containing bedaquiline, pretomanid, and linezolid to treat rifampicin-resistant tuberculosis: an individual patient data meta-analysis. Clin Infect Dis. 2024;78(3):730-741. doi: 10.1093/cid/ciad653
  18. Ahmad HA. P-1386. Real-world safety profile of pretomanid: an analysis of FAERS data. Open Forum Infect Dis. 2026;13(Suppl 1):ofaf695.1573. doi: 10.1093/ofid/ofaf695.1573
  19. Shah AR, Desai KN, Maru AM. Evaluation of hematological parameters in pulmonary tuberculosis patients. J Fam Med Prim care. 2022 Aug;11(8):4424–8
  20. Lange C, Abubakar I, Alffenaar J-WC, Bothamley G, Caminero JA, Carvalho ACC, et al. Management of patients with multidrug-resistant/extensively drug-resistant tuberculosis in Europe: a TBNET consensus statement. Vol. 44, The European respiratory journal. England; 2014. p. 23–63

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