Emerging treatments
Oral bedaquiline/levofloxacin/linezolid-containing regimens (for MDR-TB)
In one multicentre randomised controlled trial in adults with multidrug-resistant (MDR)/rifampicin-resistant (RR)-TB (NExT trial), an all-oral 6-month levofloxacin, bedaquiline, and linezolid-containing MDR/RR-TB regimen was associated with a significantly improved 24-month World Health Organization-defined treatment outcome compared with traditional injectable-containing regimens.[87] However, drug toxicity occurred frequently in both intervention arms.
8-week regimens
In the TRUNCATE-TB trial, patients with rifampicin-susceptible pulmonary TB were randomised to either standard treatment (rifampicin and isoniazid for 24 weeks with pyrazinamide and ethambutol for the first 8 weeks) or to a strategy involving initial treatment with an 8-week regimen containing bedaquiline and linezolid, extended treatment for persistent clinical disease, monitoring after treatment, and re-treatment for relapse.[88] The study found that an 8-week regimen containing bedaquiline and linezolid was non-inferior to standard treatment with respect to the risk of a composite clinical outcome (death, ongoing treatment, or active disease) at week 96.[88]
Novel vaccine candidates
The M72/AS01E candidate vaccine contains an immunogenic fusion protein (M72) derived from two Mycobacterium tuberculosis antigens (Mtb32A and Mtb39A), combined with the AS01E adjuvant system. In a phase 2b double-blind randomised placebo-controlled trial, M72/AS01E provided approximately 50% protection against progression to active pulmonary tuberculosis for 3 years in M tuberculosis-infected, HIV-negative adults.[89][90]
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