Emerging treatments

Isoniazid/rifapentine (for LTBI)

A 1-month regimen of daily isoniazid plus rifapentine has been evaluated in a randomized, open-label, phase 3 trial and found to be noninferior to 9 months of isoniazid alone for preventing TB in patients with HIV who were living in areas of high TB prevalence or who had evidence of latent TB infection (LTBI).[102] US guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV include the regimen as an alternative option for treatment of LTBI in people with HIV.[64] However, it is not currently recommended in the National Tuberculosis Controllers Association and Centers for Disease Control and Prevention guidelines.[71]

Oral bedaquiline/levofloxacin/linezolid-containing regimens (for MDR-TB)

In one multicenter randomized controlled trial in adults with multidrug-resistant (MDR)/rifampin-resistant (RR)-TB, 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.[103] However, drug toxicity occurred frequently in both intervention arms. 

8-week regimens

In the TRUNCATE-TB trial, patients with rifampin-susceptible pulmonary TB were randomized to either standard treatment (rifampin 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 retreatment for relapse.[104]​ The study found that an 8-week regimen containing bedaquiline and linezolid was noninferior to standard treatment with respect to the risk of a composite clinical outcome (death, ongoing treatment, or active disease) at week 96.[104] 

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 randomized 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.[105][106]

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