Pioneering research presented at The Union World Conference on Lung Health has shed light on experimental strategies to combat extensively drug-resistant tuberculosis (XDR-TB).
The findings, which span safety, tolerance, and efficacy of new treatment regimens, signal a significant step forward in addressing this challenging global health threat.
Tailored Treatments for Pre-XDR TB
Results from the groundbreaking endTB-Q trial, led by the endTB consortium, revealed an innovative, shorter treatment strategy for pre-XDR TB. This trial, the first-ever randomized and internally controlled study of its kind, tested a regimen of bedaquiline, delamanid, clofazimine, and linezolid (BDCL).
The trial achieved 87% favorable outcomes for participants on the shorter treatment regimen compared to 89% in the control group. For patients with non-severe TB, a six-to-nine-month BDCL treatment proved highly effective, with a 93% cure rate. However, for those with severe TB, relapse rates indicated the need for longer regimens.
“Our trial innovated in several important ways,” said Dr. Lorenzo Guglielmetti, Co-Principal Investigator of the endTB-Q trial and Médecins Sans Frontières Director for the endTB project. “Emerging evidence highlights that the BDCL regimen may be well-suited for people with non-severe TB disease but riskier for those with severe disease. Tailored approaches are essential to ensure success.”
Bedaquiline Safe for Children and Adolescents
Another critical study presented by the NIH-funded IMPAACT network, including experts from Stellenbosch University, focused on the safety of bedaquiline in infants, children, and adolescents with drug-resistant TB. The findings confirmed that the antibiotic is both safe and well-tolerated in these vulnerable groups, paving the way for broader access to effective treatments.
“The P1108 trial has paved the way for access, finally, to effective, shorter, and safer treatment for children with drug-resistant TB,” said Prof. Simon Schaaf. “For too long, children with TB have been left behind.”
Optimizing Treatment for XDR-TB Patients
A separate TBNet-led study examined outcomes for people with XDR-TB under the World Health Organization’s updated definition, which includes resistance to fluoroquinolones and at least one Group A drug (bedaquiline or linezolid). Findings indicated that each additional effective drug in a treatment regimen significantly reduced the odds of an unsuccessful outcome.
“This highlights the urgent need for optimized drug susceptibility testing methods and expanding access to new TB compounds for people with life-threatening TB,” the researchers emphasized.
Speaking at the conference, Dr. Cassandra Kelly-Cirino, Executive Director of The Union, stressed the gravity of the antimicrobial resistance crisis.
“Antimicrobial resistance is among the greatest global health threats we face today. For people at risk of TB, this threat is multiplied,” she said. “The research presented this week represents invaluable progress in managing this challenge and offers hope to patients of all ages living with extensively drug-resistant TB.”
TB survivor and advocate Akshata Acharya shared her experience of living with multidrug-resistant TB, calling for greater patient rights and access to treatment.
“TB is more than just a physical disease—it has a massive emotional toll,” Acharya said. “We need to keep advocating for better access to treatment for drug-resistant TB, especially for those facing barriers, such as women, the elderly, and LGBTQIA++ populations.”
The findings presented at the conference underline the potential for shorter, more effective, and tailored treatment regimens to transform the outlook for people with drug-resistant TB. With global collaboration and investment, these advances could bring new hope to millions battling this devastating disease.