Testing the usage of a short regimen therapy to treat tuberculosis
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Reviewed by Dat Tien Nguyen, B.A, ScM.
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Posted on March 13th, 2023
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The current regimen most commonly used to treat tuberculosis includes rifampin for 6 months. This strategy is highly effective when implemented perfectly; however, the long-term duration of the treatment limits the effectiveness in underdeveloped areas. Thus, the Singapore National Medical Research Council had conducted a study to assess the effectiveness of a shorter regimen in treating tuberculosis.
The trial included a total of 541 adults who were recruited from multiple centers located in Indonesia, the Philippines, Thailand, Uganda, and India. They were diagnosed using chest radiographs and the nucleic acid test Xpert MTB/RIF test. These patients were assigned to receive either the current standard strategy or 2 shorter regimens, and the treatment’s effectiveness was assessed in their ability of preventing death and active disease after 2 years. Patients in the standard regimen receive 24 weeks of rifampin and isoniazid and 8 weeks of pyrazinamide and ethambutol in the beginning. The other was giving 8 weeks of either Rifampin and Linezolid or Bedaquiline and Linezolid; the treatment would be extended for an additional 4 weeks in patients with persistent disease. The study found that the 8-week Rifampin and Linezolid regimen was significantly less effective in curing tuberculosis and preventing death than the standard 24-week Rifampin-Isoniazid regimen. However, the 8-week Bedaquiline–Linezolid regimen was equivalent to the standard 24-week Rifampin-Isoniazid regimen in preventing mortality and treating active tuberculosis. Thus, this treatment can be considered in settings where treatment adherence is not guaranteed and resources are limited.
The trial included a total of 541 adults who were recruited from multiple centers located in Indonesia, the Philippines, Thailand, Uganda, and India. They were diagnosed using chest radiographs and the nucleic acid test Xpert MTB/RIF test. These patients were assigned to receive either the current standard strategy or 2 shorter regimens, and the treatment’s effectiveness was assessed in their ability of preventing death and active disease after 2 years. Patients in the standard regimen receive 24 weeks of rifampin and isoniazid and 8 weeks of pyrazinamide and ethambutol in the beginning. The other was giving 8 weeks of either Rifampin and Linezolid or Bedaquiline and Linezolid; the treatment would be extended for an additional 4 weeks in patients with persistent disease. The study found that the 8-week Rifampin and Linezolid regimen was significantly less effective in curing tuberculosis and preventing death than the standard 24-week Rifampin-Isoniazid regimen. However, the 8-week Bedaquiline–Linezolid regimen was equivalent to the standard 24-week Rifampin-Isoniazid regimen in preventing mortality and treating active tuberculosis. Thus, this treatment can be considered in settings where treatment adherence is not guaranteed and resources are limited.