BPaL, A New Oral Regimen for Drug-Resistant Tuberculosis

Abstract Given the lack of effective treatments for complicated multidrug-resistant tuberculosis (MDR-TB) and extensive drug-resistant tuberculosis (XDR-TB), it will be challenging to achieve the World Health Organization (WHO) goal to end the global TB epidemic by 2035. The treatment of MDR- and XDR-TB consists of 4–6 drug regimens for durations of 1–2 years. In this open label, single-group study in 3 sites, the safety and efficacy of a 3-drug regimen, including bedaquiline, linezolid, and pretomanid (BPaL), was assessed for treatment of MDR- and XDR-TB. The all-oral, 6-month BPaL regimen for XDR- and complicated MDR-TB patients was highly effective, as 90% of patients had a favorable outcome. However, the incidence and severity of adverse effects caused by linezolid is alarming. The Nix-TB study shows that a highly effective, all-oral, short regimen for MDR- and XDR-TB can be implemented in both clinical and programmatic settings.