CROI 2023: Shorter 2-month TB treatment regimen works as well as 6-month regimen

Researchers at the Conference on Retroviruses and Opportunistic Infections in Seattle presented findings on Feb. 20 from the TRUNCATE-TB trial showing that a shorter, eight-week regimen for treating tuberculosis is just as efficacious and safe as the standard six-month regimen, which has been the standard of care for decades to treat TB. These findings may open the door to implementing shorter treatment regimens that improve adherence to treat and cure TB, which, up until the COVID-19 pandemic, had been the biggest infectious disease killer globally.

The standard six-month rifampin-based regimen is long and difficult to adhere to, researchers said, contributing to drug resistance as patients fall off the treatment cascade without completing a full course of antibiotics and to ongoing challenges to meet global TB control targets. Long treatment courses also put pressure on already-strained national treatment programs, according to the researchers.

Reduced duration of treatment could improve treatment adherence, reduce drug resistance and allow for program resources to be redeployed to find and treat more patients, the researchers noted.

Investigators in the TRUNCATE-TB trial enrolled 675 participants across 18 sites in high TB-burden countries, including Indonesia, the Philippines, Thailand, Uganda and India. Only four participants withdrew consent or were lost to follow up. Participants were randomized into several treatment arms, with the standard arm receiving rifampin and isoniazid for 24 weeks and pyrazinamide and ethambutol for the first eight weeks. The arm that received an eight-week regimen of bedaquiline and linezolid, along with isoniazid, pyrazinamide and ethambutol, showed as much safety and efficacy as the standard six-month rifampin-based regimen, said study author Nicholas Paton, MD, of the National University of Singapore.

Participants reported a higher level of motivation to adhere to the eight-week course than the standard longer course, he added. Increased patient satisfaction along with better adherence and potentially reduced costs associated with implementing a shorter regimen hold promise for the global TB response, researchers said, moving us closer and closer to the holy grail of short-course TB treatment.