TB Treatment Shortened to One Month, IPB University Doctor: Only for Latent TB
Dr dr Desdiani, SpP, MKK, MSc (MBioEt), a lecturer at the Faculty of Medicine and Nutrition at IPB University, commented on the proposal to shorten tuberculosis (TB) treatment to just one month.
Dr Desdiani emphasized the need to distinguish between active TB and latent TB infection. Some preventive treatment regimens for latent TB are indeed shorter in duration. The medications, rifapentin and isoniazid, are taken daily for one month.
“While some preventive regimens for latent TB do last one month, this cannot be used as a basis to claim that active TB can be cured in the same timeframe,” she added.
According to her, the two conditions are clinically distinct, so the preventive regimen for latent TB cannot be used to justify the claim that active pulmonary TB can be cured in one month. “So, a one-month treatment is only for latent TB, not active TB,” she emphasized.
She also noted that shorter treatment regimens must be supported by clinical evidence, and the duration cannot be standardized without considering the type of disease, the patient’s condition, and the effectiveness of the therapy. “Shorter treatment isn’t always a worse option, but its implementation must be based on solid research,” she said.
Current Standard: 4–6 Months
Dr Desdiani explained that the standard regimen that has long been used for new cases of drug-sensitive active pulmonary TB generally lasts six months or longer (2HRZE/4HR), depending on the patient’s condition.
During the first two months, patients receive a combination of isoniazid, rifampin, pyrazinamide, and ethambutol. Treatment continues for four months with isoniazid and rifampicin.
Research shows that the duration can be shortened under certain conditions. Currently, treatment for active TB can be shortened to as little as four months using a regimen of rifapentine, isoniazid, pyrazinamide, and moxifloxacin. This is based on Study 31/A5349 in The New England Journal of Medicine (2021), which found that the four month regimen was non-inferior to the standard six-month regimen in drug-sensitive pulmonary TB patients who met the study criteria.
“This means its effectiveness is no worse than standard therapy within the defined evaluation parameters.”
However, she continued, the four-month regimen tested without moxifloxacin failed to demonstrate noninferiority. “This means that success is determined not only by the duration of therapy but also by the combination of drugs,” said Dr Desdiani. The four month regimen can also be applied to some children and adolescents with non-severe TB, but not to all patients.
Preventing Drug Resistance
According to Dr Desdiani, if treatment is stopped too soon or the regimen is inadequate, patients are at risk of treatment failure, which increases the risk of relapse and contributes to the development of drug resistance.
“If resistance occurs, patients may require a different combination of drugs, as well as more complex and longer-term therapy. Additionally, patients with pulmonary TB who are still contagious risk continuing to transmit the bacteria to those around them,” she said.
Therefore, she recommends that patients not stop taking their medication on their own once their cough subsides. If they experience side effects or have difficulty adhering to the treatment regimen, patients should consult a healthcare provider.
Focus on Accelerating Care
While new drugs are being tested, he noted, efforts to accelerate treatment should focus on early diagnosis, ease of testing, appropriate therapy, drug availability, and patient support until treatment is completed.
The success of the program is measured by the number of patients who complete the appropriate regimen and avoid relapse. “The one month duration itself is still a potential drug candidate, and its use depends on the results of clinical trials and approval from the relevant authorities,” he emphasized. (dh) (IAAS/HNY)
