Safety and Effectiveness of Contezolid versus Linezolid in Drug-Resistant Tuberculosis: A 12-Month Retrospective Study from China

Yu Xiao,* Peng-Fei Huang,* Lei Xie, Lei Gao, Yi Han, Shuang Liu, Ya-Xue Liang, Yan-Jun Xiong, Hua Wang Department of Tuberculosis, Anhui Provincial Chest Hospital (Anhui Institute of Tuberculosis Control), Hefei, Anhui, 230022, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yan-Jun Xiong, Department of Tuberculosis, Anhui Provincial Chest Hospital, Anhui Institute of Tuberculosis Control, No. 392, Jixi Road, Hefei, Anhui, 230022, People’s Republic of China, Tel +86 13855183415, Email 67453937@qq.com Hua Wang, Department of Tuberculosis, Anhui Provincial Chest Hospital, Anhui Institute of Tuberculosis Control, No. 392, Jixi Road, Hefei, Anhui, 230022, People’s Republic of China, Tel +86 13395694530, Email 1726553540@qq.comBackground: Contezolid (CZD), a novel oxazolidinone, is a promising therapeutic option for the treatment of Mycobacterium tuberculosis. However, clinical evidence of its safety and efficacy in managing drug-resistant tuberculosis (DR-TB) remains limited.Methods: A retrospective analysis was performed on 135 patients with DR-TB treated at Anhui Chest Hospital between January 2022 and September 2024, including 27 on CZD-based regimens and 108 on linezolid (LZD)-based regimens. Drug-related adverse events (AEs), including bone marrow suppression, peripheral neuropathy, optic neuritis, and gastrointestinal reactions, were systematically recorded. Therapeutic efficacy was comprehensively evaluated based on clinical symptoms, radiological findings, and microbiological results. The 12-month safety and efficacy of the two regimens in DR-TB were assessed.Results: The incidence of AEs in the LZD group reached 54.63%, significantly higher than the 3.7% observed in the CZD group (χ2 = 22.69, P < 0.001). Notably, the rates of bone marrow suppression and peripheral neuropathy in the LZD group were 22.22% and 27.78%, respectively, whereas no such AEs were reported in the CZD group (P = 0.004; P < 0.001, respectively). Regarding efficacy, CZD and LZD showed comparable outcomes in patients with DR-TB (P = 0.491).Conclusion: CZD may have clinical efficacy comparable to LZD in treating DR-TB, while appearing to offer an improved safety profile, notably in reducing bone marrow suppression and peripheral neuropathy.Keywords: contezolid, linezolid, drug-resistant tuberculosis, safety, effectiveness