Contezolid in tuberculosis therapy: a retrospective analysis of real-world practice in China

<title>Abstract</title> Background Linezolid (LZD), a pivotal agent in the treatment of tuberculosis (TB), is constrained by its adverse event (AE) profile. Contezolid (CZD), an innovative oxazolidinone derivative approved in China in 2021 for complicated skin and soft tissue infections, has been designed to refine the chemical structure of LZD, preserving its robust antimicrobial potency while mitigating toxic AEs. The present study assesses the efficacy and safety of CZD in the real-world management of TB. Methods A retrospective analysis of patients who were off-label prescribed CZD for TB treatment across three hospitals in southern China between September 2022 and October 2024 was conducted. Demographic clinical details of the patients were retrieved and analyzed. Results The study included 38 adults (11 female, 27 male) with an average age of 53.03 years. Of these, 63.16% had been diagnosed with drug-resistant TB. The majority of patients (73.68%, 28/38) initially received LZD-based regimens and were subsequently switched to CZD due to intolerable AEs, which were typically myelosuppression and neuropathy of Grade 2 or 3 severity; after at least one month on CZD-containing regimens, LZD-related AEs resolved or improved in 60.71% (17/28) of cases. 10 patients were initiated on CZD due to specific health considerations. Clinical responses that included safety and efficacy were observed in the majority of patients (97.37%, 37/38), including those who initially received LZD-based regimens (96%,27/28). Conclusion The findings of this study indicate that CZD is an efficacious and safe treatment option for TB, particularly for patients with severe comorbidities and LZD-intolerable. Further large-scale randomized trials are needed to confirm these results.