Three All-Oral Shortened Regimens Noninferior for Rifampin-Resistant TB

THURSDAY, Feb. 6, 2025 (HealthDay News) — Three all-oral shortened regimens have noninferior efficacy compared with standard therapy for fluoroquinolone-susceptible, rifampin-resistant tuberculosis, according to a study published in the Jan. 30 issue of the New England Journal of Medicine.

Lorenzo Guglielmetti, M.D., Ph.D., from Médecins Sans Frontières in Paris, and colleagues conducted a phase 3, multinational, noninferiority trial to compare standard therapy for treatment of fluoroquinolone-susceptible, rifampin-resistant tuberculosis to five nine-month oral regimens, including combinations of bedaquiline (B), delamanid (D), linezolid (L), levofloxacin (Lfx) or moxifloxacin (M), clofazimine (C), and pyrazinamide (Z). A total of 754 participants were randomly assigned to one of five combinations or standard therapy; 699 were included in the modified intention-to-treat analysis and 562 were included in the per-protocol analysis. The primary end point was a favorable outcome at week 73, defined by two negative sputum culture results or favorable bacteriologic, clinical, and radiologic evolution. The noninferiority margin was −12 percentage points.

The researchers found that 80.7 percent of the patients in the standard-therapy group had favorable outcomes in the modified intention-to-treat analysis. In the modified intention-to-treat population, the risk difference between standard therapy and each of the four new regimens was noninferior: 9.8, 8.3, 4.6, and 2.5 percentage points for BCLLfxZ, BLMZ, BDLLfxZ, and DCMZ, respectively. In the per-protocol population, the differences were similar, apart from DCMZ, which was not noninferior. Across the regimens, the proportion of participants with grade 3 or higher adverse events was similar.

“The results of this trial support the noninferior efficacy of three all-oral shortened regimens for the treatment of rifampin-resistant tuberculosis,” the authors write.

Two authors disclosed ties to the biopharmaceutical industry.

Abstract/Full Text