Incidence and Predictors of QTC Prolongation Among Drug-Resistant Tuberculosis Patients Receiving Bedaquiline-Based TB Regimens in Uganda: A Countrywide Retrospective Cohort Study.
6 affiliations
- 1Child and Family Foundation, Kampala, Uganda.
- 2Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
- 3Uganda Institute of Public Health, Ministry of Health, Kampala, Uganda.
- 4Division of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda.
- 5Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda.
- 6Makerere University Lung Institute, Kampala, Uganda.
Abstract
Background
Bedaquiline improves culture conversion in drug-resistant tuberculosis (DR-TB) treatment; its main safety concern is QTc prolongation, particularly when combined with other anti-TB drugs. This study assessed the incidence and predictors of QTc prolongation among DR-TB patients receiving bedaquiline under programmatic conditions in Uganda.Methods
We conducted a retrospective cohort study using medical records from 14 DR-TB treatment sites across Uganda (January 2017-December 2022). Data on demographics, clinical characteristics, bedaquiline-based regimens, treatment duration, and QTc intervals were collected. Incidence rates with 95% CIs were calculated for QTc prolongation, while modified Poisson regression was used to identify predictors of QTc prolongation.Results
Data were abstracted from 532 patients, 70.9% of whom were male. The mean (SD) age was 41.4 (15.9) years, and 34.6% were coinfected with HIV. The baseline mean (SD) QTc was 426.8 (28.4) ms, with a median follow-up (interquartile range) of 10.3 (7.2-13.5) months. The overall incidence of QTc prolongation was 12.0 cases per 1000 person-months (95% CI, 10.8-16.8). Lower body mass index (BMI; incidence rate ratio [IRR], 0.924; 95% CI, 0.860; IRR, 0.993; P = .031) increased risk of QTc prolongation. Treatment success was similar among patients with and without QTc prolongation: 73.9% (51/69) vs 68.3% (316/463); P = .873.Conclusions
An average of 12 new cases of QTc prolongation was observed for every 1000 person-months of accumulated observation time. The recommended monthly electrocardiogram monitoring should be emphasized among patients with low baseline BMI. QTc prolongation was not linked to poor treatment outcomes.
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BibTeX
@article{nasasira2026incidence,
title = {{Incidence and Predictors of QTC Prolongation Among Drug-Resistant Tuberculosis Patients Receiving Bedaquiline-Based TB Regimens in Uganda: A Countrywide Retrospective Cohort Study.}},
author = {Marble Nasasira and Kevin Ouma Ojiambo and Daniel Iraguha and Joseph Baruch Baluku},
journal = {Open forum infectious diseases},
year = {2026},
month = oct,
doi = {10.1093/ofid/ofag637},
url = {https://europepmc.org/article/MED/42898576},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Incidence and Predictors of QTC Prolongation Among Drug-Resistant Tuberculosis Patients Receiving Bedaquiline-Based TB Regimens in Uganda: A Countrywide Retrospective Cohort Study.
AU - Marble Nasasira
AU - Kevin Ouma Ojiambo
AU - Daniel Iraguha
AU - Joseph Baruch Baluku
PY - 2026
DA - 2026/10/05
JO - Open forum infectious diseases
DO - 10.1093/ofid/ofag637
UR - https://europepmc.org/article/MED/42898576
AB - Background Bedaquiline improves culture conversion in drug-resistant tuberculosis (DR-TB) treatment; its main safety concern is QTc prolongation, particularly when combined with other anti-TB drugs. This study assessed the incidence and predictors of QTc prolongation among DR-TB patients receiving bedaquiline under programmatic conditions in Uganda.Methods We conducted a retrospective cohort study using medical records from 14 DR-TB treatment sites across Uganda (January 2017-December 2022). Data on demographics, clinical characteristics, bedaquiline-based regimens, treatment duration, and QTc intervals were collected. Incidence rates with 95% CIs were calculated for QTc prolongation, while modified Poisson regression was used to identify predictors of QTc prolongation.Results Data were abstracted from 532 patients, 70.9% of whom were male. The mean (SD) age was 41.4 (15.9) years, and 34.6% were coinfected with HIV. The baseline mean (SD) QTc was 426.8 (28.4) ms, with a median follow-up (interquartile range) of 10.3 (7.2-13.5) months. The overall incidence of QTc prolongation was 12.0 cases per 1000 person-months (95% CI, 10.8-16.8). Lower body mass index (BMI; incidence rate ratio [IRR], 0.924; 95% CI, 0.860; IRR, 0.993; P = .031) increased risk of QTc prolongation. Treatment success was similar among patients with and without QTc prolongation: 73.9% (51/69) vs 68.3% (316/463); P = .873.Conclusions An average of 12 new cases of QTc prolongation was observed for every 1000 person-months of accumulated observation time. The recommended monthly electrocardiogram monitoring should be emphasized among patients with low baseline BMI. QTc prolongation was not linked to poor treatment outcomes.
SN - 2328-8957
ER -