Tuberculosis patients see dramatic cut in treatment duration, treatment effectiveness remains
Published: 05 Apr 2023
Copyright: ryanking999
Tuberculosis (TB) patients can look forward to a much-shortened treatment period, compared to the current six-month treatment regimen used globally, based around the antibiotic rifampicin, or rifampin as it is called in the United States.
In a ground-breaking study conducted across Asia and Uganda, Africa, the research team from the Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine), National University Hospital (NUH) and Singapore Clinical Research Institute (SCRI), led by Professor Nicholas Paton from the Department of Medicine and Infectious Diseases Translational Research Programme (NUS Medicine), found that a TB treatment strategy with an initial 8-week treatment period followed by retreatment of a small minority who were not cured, showed the same efficacy level as the standard 6-month treatment, but halved the average total time on treatment.
The TRUNCATE-TB trial recruited 675 people who were diagnosed with pulmonary TB and randomly allocated them to receive the standard treatment for six months or to receive the TRUNCATE strategy which involves initial treatment with an intensive two-month (8-week) antibiotic regimen, with the possibility of extension if needed, followed by close monitoring and early retreatment for those who were not cured.
The team tested the strategy with four different initial 8-week drug combinations using a new type of trial design to identify whether any of the treatment combinations were doing less well and needed to be discontinued early. Trial participants were each followed up for 2 years to see how many patients were still on treatment for TB or had active TB at that time.
In the final analysis, two of the strategy groups were compared against the standard treatment group. One of these strategy groups – in which people were given an initial 8-week treatment combination containing bedaquiline[1] and linezolid with three standard tuberculosis drugs (isoniazid, pyrazimamide and ethambutol) – was found to be as good as the standard treatment in clinical outcome at 2 years. But, in this strategy group the average total time on treatment was 85 days, compared to 180 days for standard treatment group.
TB is caused by a Mycobacterium tuberculosis bacterial infection that affects the lungs, which multiplies and destroy the tissues in the body. TB germs can be effectively transmitted through the air when a TB patient coughs, sneezes, speaks or sings and remain in the environment for a few hours at a time.
The TRUNCATE-TB trial was designed and coordinated from Singapore across a network of 18 sites in Indonesia, Philippines, Thailand, India and Uganda, Africa. This multi-site trial was supported by SCRI, which provided support in patient randomisation, data management, pharmacovigilance, and statistical analysis.
The findings are published in the New England Journal of Medicine.
Read more in the press release.
[1] Bedaquiline is FDA-registered (since Dec 2012) for multi-drug resistant TB and is currently not registered in Singapore.
