Treatment-shortening regimens for tuberculosis: updates and future priorities.

In the past 2 years, remarkable advances have been made in shortening tuberculosis (TB) treatment. In particular, four clinical trials (Study 31/A5349, Nix-TB, ZeNix and TB-PRACTECAL) have provided evidence of the efficacy of regimens based on new and repurposed drugs: the 4-month regimen for drug-susceptible TB, and the 6-month bedaquiline-pretomanid-linezolid regimen with or without moxifloxacin for multidrug-resistant/rifampicin-resistant TB. Even if the evidence at the basis of these new regimens is compelling, several questions remain open, particularly concerning linezolid dose finding, the upsurging threat of bedaquiline-resistant Mycobacterium tuberculosis and the feasibility of applying these results to the paediatric population. Several ongoing trials may fill the remaining gaps and produce further reliable evidence to address the outstanding questions in TB treatment shortening.
Competing Interests: Conflict of interest: R. Duarte is supported by the Institute of Public Health of the University of Porto. C. Lange is supported by the German Center of Infection Research; and reports consulting fees received from Insmed, outside the submitted work; speaker's honoraria received from Insmed, Gilead and Janssen, outside the submitted work; and acting as a Data Safety Board member for MSF, outside the submitted work. P.P.J. Phillips reports receiving grants, via institution, from CDC, Radboud University, LMU Munich and USAID, outside the submitted work; receiving consulting fees from Bill and Melinda Gates Medical Research, outside the submitted work; and being a member of the DSMB for the Nix-TB and ZeNix trials, outside the submitted work. The remaining authors have nothing to disclose.
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