Tinjauan Sistematis: Efektivitas, Keamanan, dan Efektivitas Biaya Regimen BPaL dan BPaLM pada Pasien Tuberkulosis Resisten Obat (TB-RO)

M. Hasan Andryanto, Fauna Herawati, Soedarsono Soedarsono, Umi Fatmawati

Abstract

Tuberkulosis resisten obat (TB-RO) merupakan tantangan utama pengendalian tuberkulosis karena keberhasilan pengobatan secara global masih rendah dan regimen konvensional memerlukan durasi terapi yang panjang dengan toksisitas tinggi. Meskipun beberapa uji klinis telah mengevaluasi efektivitas regimen BPaL dan BPaLM, bukti yang mengintegrasikan efektivitas, keamanan, dan efektivitas biaya dalam satu kajian masih terbatas, khususnya sebagai dasar implementasi di negara dengan beban TB-RO tinggi seperti Indonesia. Tinjauan sistematis ini bertujuan mensintesis bukti terkini mengenai efektivitas, keamanan, dan efektivitas biaya regimen BPaL dan BPaLM pada pasien TB-RO. Tinjauan sistematis dilakukan melalui pencarian artikel pada PubMed dan Google Scholar untuk publikasi tahun 2019–2024 menggunakan kriteria inklusi dan eksklusi. Sebanyak sembilan artikel memenuhi kriteria dan dianalisis. Penggunaan regimen BPaL dan BPaLM menunjukkan keberhasilan pengobatan yang tinggi sekitar 72–93%, lebih tinggi dibandingkan regimen standar. Efek samping yang paling sering dilaporkan seperti neuropati perifer, myelosupresi, neuropati optik, peningkatan enzim hati dan perpanjangan interval QTc yang terutama berkaitan dengan penggunaan linezolid dan bedaquiline. Kejadian efek samping penggunaan linezolid dosis 1200 mg lebih tinggi dibandingkan dosis 600 mg sehingga diperlukan pemantauan rutin selama pengobatan. Regimen BPaL dan BPaLM menghasilkan penghematan biaya sekitar 9–78% dibandingkan regimen konvensional pada berbagai negara. Secara keseluruhan, regimen BPaL dan BPaLM memberikan efektivitas pengobatan yang tinggi, profil keamanan yang dapat dikelola melalui pemantauan rutin, serta berpotensi menurunkan biaya pengobatan dibandingkan regimen konvensional. Temuan ini mendukung implementasi kebijakan penatalaksanaan TB-RO di Indonesia yang telah mengadopsi regimen BPaL dan BPaLM sesuai rekomendasi WHO guna meningkatkan keberhasilan pengobatan, menurunkan toksisitas terapi, dan mengoptimalkan efisiensi pembiayaan kesehatan.

Keywords

Biaya; BPaL; BPaLM; Efektivitas, Keamanan; TB-RO

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DOI: https://doi.org/10.20961/jpscr.v11i2.91463

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