Tuberculosis (TB) is one of the oldest dreadful diseases caused by the bacillus Mycobacterium tuberculosis, infecting millions and a leading cause of death worldwide. Despite being a preventable and curable disease, the WHO reported in 2023 that TB continues to cause almost 2 million deaths annually, almost twice as many deaths as HIV/AIDS. Every year, around 10 million people contract TB, and the figure has been increasing since 2021. [2]
TB, a long-standing human disease, has affected various figures, including kings, poets, politicians, revolutionaries, writers, activists, and actors. Only by working together, we can turn the tide against this ancient killerDr. Tedros Adhanom Ghebreyesus, Director-General, World Health Organization
The traditional TB treatment regimens are quite lengthy, lasting 6 months or more thus increasing the pill burden, decreasing medication adherence, and frequent adverse drug reactions.
Which could lead to:
Disease recurrence
Drug resistance
Prolonged courses of many medications
Higher costs of treatment
Increase the physical and psychological toll on the patient and family
To overcome these challenges, the American Thoracic Society (ATS), Centers for Disease Control and Prevention (CDC), European Respiratory Society (ERS), and Infectious Diseases Society of America (IDSA) have released new clinical practice guidelines, published in the American Journal of Respiratory and Critical Care Medicine. These guidelines were adapted from the WHO 2022 consolidated guidelines on TB and are based on reviews from recent clinical trial data.
The Joint Panel comprised 25 global experts in pulmonary medicine, infectious diseases, pediatrics, epidemiology, and public health.
During my own treatment I felt the weight of 16 pills in my hand every morning, and of stigma, financial cost and isolation. I felt the added burden on my family, the medication side effects, and the physical manifestations of the disease. Progress to shorten this journey and to ease these burdens is valued by patientsKelly Holland, Member of We Are TB (patient advocacy organization)
| Drug Susceptible TB (DS-TB) | Isoniazid-H, Rifampin-R, Pyrazinamide-P, Moxifloxacin-M, Bedaquiline-B, Linezolid-L | |
|---|---|---|
| 1. Isoniazid and Rifampin susceptible TB in Adults (Aged 12 years & older) | 4-month regimen | First 2 months: Isoniazid + Rifapentine + Pyrazinamide + Moxifloxacin Next 2 months: Isoniazid + Rifapentine + Moxifloxacin |
| 2. Non-severe TB in Children with no evidence of multidrug-resistant [MDR]/rifampin-resistant-TB (Aged 3 months to 16 years) | 4-month regimen (2HRZ(E)/2HR) | First 2 months: Isoniazid + Rifampin + Pyrazinamide + Ethambutol Next 2 months: Isoniazid + Rifampin |
| Drug Resistant TB (DR-TB) | Isoniazid-H, Rifampin-R, Pyrazinamide-P, Moxifloxacin-M, Bedaquiline-B, Linezolid-L | |
|---|---|---|
| 1. Rifampin-resistant, Fluoroquinolone-resistant TB (Aged 14 years & older) | 6-month BPaL regimen | Bedaquiline + Pretomanid + Linezolid |
| 2. Rifampin-resistant, Fluoroquinolone-susceptible TB (Aged 14 years & older)) | 6-month BPaLM regimen | Bedaquiline + Pretomanid + Linezolid + Moxifloxacin |
The traditional 6-month regimens are replaced with the new 4-month regimen for DS-TB treatment. Also additionally, the guideline calls for a 6-month BPaL regimen instead of the prior 15-month or longer regimens for DR-TB.
Reduced pill burden
Increase medication adherence
Fewer side effects and toxicity
Reduce economic and social burden
Reduced morbidity and mortality
Improve treatment outcomes and patient quality of life
Further research is needed to assess these newest regimens' cost-effectiveness, impact on health equity, acceptability, and feasibility. All UN and WHO Member States have endorsed the objective of ending the worldwide tuberculosis epidemic by 2030. Urgent action is needed to achieve this goal.[2]
TB has probably returned to being the world’s leading infectious disease killer. Only through our collective determination can we make significant strides in our battle to end TB once and for allDr. Tereza Kasaeva, Director- WHO Global Tuberculosis Programme
With this vision of a TB-free world, a shift to a shorter, safer and all-oral regimen has set a milestone in TB management globally.
References:
American Thoracic Society, Centers for Disease Control and Prevention, European Respiratory Society, and Infectious Diseases Society of America. "Updates on the Treatment of Drug-Susceptible and Drug-Resistant Tuberculosis: An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline." American Journal of Respiratory and Critical Care Medicine. Accessed January 20, 2025. https://www.atsjournals.org/doi/10.1164/rccm.202410-2096ST.
World Health Organization. "Global Tuberculosis Programme: TB Reports." Accessed January 21, 2025. https://www.who.int/teams/global-tuberculosis-programme/tb-reports.
(Input from various sources)
(Rehash/Dr. Disha Merlyn Mathias/MSM)