Breakthrough in Tuberculosis Treatment: WHO Introduces New Regimens to Combat Drug-Resistant TB

This article discusses the World Health Organization's latest updates to the treatment of drug-resistant tuberculosis, highlighting the introduction of new 6-month and 9-month all-oral regimens. These updates aim to provide more effective, shorter, and safer treatment options for patients with multidrug-resistant TB, including children, adolescents, and pregnant women. The article emphasizes the importance of personalized treatment decisions based on individual patient profiles and drug susceptibility testing.

Tuberculosis (TB) continues to be a significant global health challenge, with drug-resistant strains posing a particularly difficult hurdle. In response to this, the World Health Organization (WHO) has introduced key updates to the treatment of drug-resistant tuberculosis (DR-TB) in its latest guidelines, which prioritize more effective and shorter all-oral treatment regimens. These updates are not just incremental changes; they represent a crucial shift in how we tackle multidrug-resistant and rifampicin-resistant TB (MDR/RR-TB).

A New Hope: Shorter, More Effective Treatment Regimens

One of the most significant updates is the introduction of a new 6-month regimen known as BPaLM, which includes bedaquiline, pretomanid, linezolid (600 mg), and moxifloxacin. This regimen is a game-changer for eligible patients, especially those aged 14 and above, who have not previously been exposed to these drugs. The BPaLM regimen can replace the traditionally longer treatments that extend over nine months or more, offering a more patient-friendly option that does not compromise on effectiveness.

For patients with pre-extensively drug-resistant TB (pre-XDR-TB) or those resistant to fluoroquinolones, the BPaLM regimen can be modified to exclude moxifloxacin (resulting in the BPaL regimen). This flexibility allows healthcare providers to tailor treatments to individual patient needs while ensuring the best possible outcomes.

Expanding Access: The BDLLfxC Regimen

Another groundbreaking update is the introduction of the BDLLfxC regimen, which also spans six months and includes bedaquiline, delamanid, linezolid (600 mg), levofloxacin, and clofazimine. This regimen is especially noteworthy because it broadens the scope of patients who can benefit from shorter treatments, including children, adolescents, and pregnant women—groups that were previously unable to use the BPaLM regimen due to a lack of safety data on pretomanid.

The BDLLfxC regimen can be adjusted based on fluoroquinolone resistance, allowing for the exclusion of either levofloxacin or clofazimine, depending on drug susceptibility testing (DST) results. This adaptability ensures that treatment can commence without delay, even if full DST results are not immediately available.

Longer Isn't Always Better: Rethinking 9-Month Regimens

While shorter regimens are the focus of the new guidelines, WHO also reassessed and modified the existing 9-month all-oral treatment options. These regimens, which include combinations such as BLMZ, BLLfxCZ, and BDLLfxZ, are now preferred over the older, longer treatments for patients without fluoroquinolone resistance and with no prior exposure to key second-line drugs like bedaquiline and linezolid.

The preference for these shorter regimens is based on their effectiveness and improved safety profiles, making them a more viable option for many patients. However, the guidelines emphasize the importance of rapid DST to rule out fluoroquinolone resistance before starting any of these treatments.

The Future of TB Treatment: Tailored and Patient-Centric

The updated guidelines reflect a broader shift towards more personalized TB care, where treatment decisions are based on individual patient profiles, including drug resistance patterns, treatment history, and the severity of the disease. This patient-centric approach is crucial in ensuring the effectiveness of the treatment while minimizing adverse effects and the risk of further drug resistance.

Looking ahead, WHO plans to release a comprehensive update to its TB treatment guidelines in 2025. This upcoming guideline will consolidate all the latest evidence and provide detailed recommendations for the use of these new regimens, further solidifying the progress made in the fight against TB.

The strides made in the treatment of drug-resistant TB mark a significant advancement in global health. With these new regimens, patients now have access to more effective, shorter, and safer treatments, bringing the world one step closer to overcoming this persistent public health threat.