Treatment-shortening regimens for tuberculosis: updates and future priorities

In the past 2 years, remarkable advances have been made in shortening tuberculosis (TB) treatment. In particular, four clinical trials (Study 31/A5349, Nix-TB, ZeNix and TB-PRACTECAL) have provided evidence of the efficacy of regimens based on new and repurposed drugs: the 4-month regimen for drug -susceptible TB, and the 6-month bedaquiline-pretomanid-linezolid regimen with or without moxifloxacin for multidrug-resistant/rifampicin-resistant TB. Even if the evidence at the basis of these new regimens is compelling, several questions remain open, particularly concerning linezolid dose finding, the upsurging threat of bedaquiline-resistant Mycobacterium tuberculosis and the feasibility of applying these results to the paediatric population. Several ongoing trials may fill the remaining gaps and produce further reliable evidence to address the outstanding questions in TB treatment shortening.

Automated summary

In the past 2 years, significant progress has been made in shortening tuberculosis treatment through clinical trials. These trials have provided evidence of the effectiveness of new and repurposed drugs, leading to the development of shorter regimens for drug-susceptible and multidrug-resistant/rifampicin-resistant TB. However, there are still questions regarding linezolid dose finding, the emergence of bedaquiline-resistant Mycobacterium tuberculosis, and the applicability of these results to pediatric patients. Ongoing trials may provide additional reliable evidence to address these outstanding questions in TB treatment shortening.