New treatment recommendations for drug-resistant tuberculosis announced by the WHO
Internationally and in Germany, the 6-month, fixed-dose combination of bedaquiline, pretomanid, linezolid and moxifloxacin (BPaLM) is primarily recommended for the treatment of multidrug-resistant (MDR) / rifampicin-resistant (RR) tuberculosis (TB) [1]. In the context of German TB care, some preconditions must be met, which are described in an amendment to the treatment guideline [2]. In the case of extensive disease or additional resistance to drugs of this combination, individually tailored MDR-TB therapy over 18 months is recommended in Germany.
New data
Based on new study data, the WHO announced recommendations for further drug combinations for the treatment of MDR/RR-TB over 6 or 9 months in a "rapid communication" on August 23, 2024 [3]. The new drug combinations achieved good treatment results in the two studies BEAT-TB and EndTB and may be suitable for a larger proportion of MDR/RR-TB cases. The indication restrictions that still exist for pretomanid due to a lack of data do not apply to these drug combinations. They are therefore also suitable for pregnant patients as well as children and adolescents.
The rapidly changing international recommendations are reviewed together with the authors of the S2k therapy guideline for their applicability in Germany. Until the next complete update of the German therapy recommendations, important innovations will be disseminated via the DZK.
Literature
- World Health Organization, WHO consolidated guidelines on tuberculosis. Module 4: treatment - drug-resistant tuberculosis treatment, 2022 update. Geneva: World Health Organization. License: CC BY-NC-SA 3.0 IGO. 2022.
- Otto-Knapp, R., et al, Therapy for MDR, pre-XDR, XDR tuberculosis and rifampicin resistance or drug intolerance to at least rifampicin - Amendment of 19.09.2023 to the S2k guideline: Tuberculosis in adults. Pneumology, 2024. 78(1): p. 35-46.
- WHO, Key updates to the treatment of drug-resistant tuberculosis: rapid communication, June 2024. Geneva: World Health Organization; 2024. 2024 .
