Tuberculosis persists as a formidable global health threat, claiming 1.5 million lives annually. Drug-resistant strains – multidrug-resistant TB (MDR-TB) and rifampicin-resistant TB (RR-TB) – exacerbate this crisis, affecting 500,000 people worldwide. The World Health Organization reports alarming resistance rates: 7% of new TB cases and 21% of retreatment cases exhibit resistance. To combat this, groundbreaking research fuels innovative treatment regimens. The WHO spearheads efforts, rapidly disseminating life-saving updates to 150,000+ healthcare professionals and millions of patients globally, ensuring timely access to cutting-edge care.
Ongoing Research on MDR/RR-TB Treatments
Recent clinical trials have tested new combinations of medicines and treatment durations to address the complexities of MDR/RR-TB better. One notable trial is the BEAT-Tuberculosis study in South Africa (NCT04062201), which evaluated a new 6-month regimen that combines bedaquiline (B), delamanid (D), and linezolid (L) with either levofloxacin (Lfx), clofazimine (C), or both. Another significant study is the endTB clinical trial (NCT02754765), which explored a group of 9-month regimens for treating MDR/RR-TB in patients without fluoroquinolone resistance.
WHO’s Guideline Development and Key Updates
In June 2024, WHO convened a Guideline Development Group (GDG) to review the latest evidence from clinical trials on MDR/RR-TB and pre-XDR-TB (pre-extensively drug-resistant TB). The goal of the meeting was to ensure that eligible patients worldwide have access to the latest and most effective treatment options.
As a result of this meeting, WHO has reaffirmed the BPaLM/BPaL regimen as the prioritized treatment of choice for drug-resistant TB. This regimen consists of bedaquiline (B), pretomanid (Pa), linezolid (L), and moxifloxacin (M), with moxifloxacin being dropped if resistance to fluoroquinolones is detected. First recommended by WHO in 2022, this treatment remains the preferred option for eligible patients. For those not eligible for the BPaLM/BPaL regimen, the new regimens emerging from recent clinical trials provide alternative solutions.
Acknowledging the Contributions to TB Treatment
WHO is grateful to the GDG members, evidence reviewers, national TB programmes, technical and funding partners, and community representatives for their contributions to this guideline update. Their collective work has been crucial in advancing TB care and treatment, offering new hope for patients with drug-resistant TB.
Conclusion
The rapid updates to treating drug-resistant tuberculosis by WHO reflect the continuous efforts to improve care for TB patients globally. With new evidence from clinical trials like BEAT-Tuberculosis and endTB, WHO has updated its guidelines to offer more effective and shorter treatment options. The reaffirmation of the BPaLM/BPaL regimen and the introduction of alternative regimens ensure that all eligible patients can access the best possible care. As WHO prepares to release its updated consolidated guidelines in 2025, these advancements highlight the importance of global collaboration in the fight against tuberculosis.