Shorter Treatment Regimen Shows Promise for Some Patients with Drug-Resistant Tuberculosis

Recent research led by an international team, including Harvard Medical School scientists, indicates that a shortened treatment course may be effective for certain individuals battling pre-extensively drug-resistant tuberculosis (pre-XDR-TB). This form of TB is particularly challenging to treat because it resists key drugs like rifampin and fluoroquinolone, making traditional long-term therapy arduous.

The study, conducted across six countries in Asia, Africa, and South America, is the first to focus exclusively on patients with pre-XDR-TB. It compared an experimental regimen using four drugs—bedaquiline, delamanid, clofazimine, and linezolid—for six or nine months against the standard longer treatment lasting 18 to 24 months. Results showed the shorter regimen achieved an 87% success rate, slightly below the 89% success of the longer treatment, demonstrating non-inferiority in most cases.

However, outcomes varied among patients. Those with more advanced lung damage did not respond as well to the shorter regimen and benefitted more from extended therapy. This highlights the importance of individualized treatment plans based on disease severity and resistance pattern.

The study underscores the need for tailored approaches to TB treatment, balancing efficacy and tolerability. While shorter regimens could improve adherence and reduce side-effects, more research is necessary to determine which patients are best suited for this option. Current guidelines are evolving, and recent WHO recommendations suggest six-month regimens regardless of disease severity, prompting a potential shift toward stratified treatment strategies.

Despite advancements, tuberculosis remains a major global health challenge, claiming approximately 1.5 million lives annually. The emergence of drug-resistant strains complicates eradication efforts, emphasizing the importance of precise, personalized treatment strategies to prevent treatment failure and reduce transmission.

The findings from this study, published in The Lancet Respiratory Medicine, advocate for ongoing research to refine TB therapies, aiming for optimal outcomes with fewer medications and shorter durations, tailored to individual patient needs.