A new recommendation from the World Health Organization has health experts hoping countries will scale up the use of shorter-treatment regimens for people with drug-resistant tuberculosis.
The aid agency on Tuesday released a rapid communication saying that patients aged 15 years and older with multidrug-resistant TB or rifampicin-resistant TB may take a six-month, all-oral regimen comprising the drugs bedaquiline, pretomanid, linezolid, and moxifloxacin, instead of a treatment regimen lasting nine months or longer. Patients with multidrug-resistant TB or rifampicin-resistant TB who have developed resistance to fluoroquinolones can also subscribe to the same six-month treatment regimen, but without moxifloxacin.
WHO added that nine-month, all-oral treatment regimens that include bedaquiline, fluoroquinolones, and linezolid are also preferred over treatment regimens that run for more than 18 months in adults and children with multidrug-resistant TB or rifampicin-resistant TB who have not previously taken second-line TB treatments, and have no resistance to fluoroquinolone.
The rapid communication came in advance of an update to WHO’s drug-resistant tuberculosis treatment guideline. It is based on data from recent studies such as TB-PRACTECAL, a clinical trial led by Médecins Sans Frontières that evaluated the BPaLM regimen; the ZeNix trial that evaluated the BPaL regimen; and with the national TB program in South Africa.
Why it matters: WHO has previously recommended the BPaL and BPaLM treatment regimens, but only under operational research conditions, meaning only very few countries can use it, said Dr. Suvanand Sahu, deputy director for the Stop TB Partnership.
What’s the catch? Experts expect challenges in implementing the new guidance.
“In the last few years, there have been several important updates to move away from longer DR-TB regimens and those that contain injectable agents. National policies are trying to keep up with the changes, and countries may be reluctant to scale BPaL up quickly, given that country budgets for second-line drugs are often planned out years in advance, and funding for TB is limited,” Dr. Sahu wrote in an email to Devex.
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