The second sub-study shows that shorter regimen is economical for the patient as well as for the service provider. Patients on BPaLM had a much shorter hospital stay and the period of follow up, as well as investigations were drastically reduced, said Sinha. "Patients could get back to their lives - get back to their studies or jobs- much quicker than those who were on standard of care regimen. BPaLM regimen is shorter, effective, safer, less toxic and more economical for patients. There is no reason why it should not be made available at the earliest to everybody who is suffering from drug-resistant TB."
BPaL regimen
The ZeNix study showed that the all oral 6 month long BPaL (Bedaquiline, Pretomanid, and Linezolid) regimen had 89% treatment efficacy in people with extensively drug-resistant TB (XDR-TB) and treatment intolerant or non responsive MDR-TB of the lungs.
"Those who do not have fluoroquinolone resistance can receive BPaLM regimen and those who are later found to have fluoroquinolone resistance, can be given BPaL regimen for the rest of their treatment", explains Leena Menghaney of MSF Access Campaign.
Toxicity related to Linezolid, one of the medicines used in these regimens, is of concern. But reducing the dosage and duration of linezolid has made the regimens more patient friendly and less toxic, without affecting their high efficacy.
"We found in TB PRACTECAL that linezolid was better tolerated in the shorter regimen arms compared to the standard of care regimen. When Linezolid is taken in smaller doses for shorter duration it is better tolerated and effective," said Sinha.
In its latest 2022 updated guidelines for the treatment of MDR-TB, WHO has recommended programmatic use of the shorter, safer and more effective all oral BPaLM and BPaL regimens in place of the existing longer regimens.
The BPaL regimen has got approval at the technical and policy level and India's National TB Elimination Programme (NTEP) is in the process of introducing it within its programme, said Dr KS Sachdeva, Director of South East Asia Regional office of the International Union Against Tuberculosis and Lung Disease (The Union), and former Deputy Director General of India's Central TB Division, Ministry of Health and Family Welfare, Government of India.
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