Lopes Sofia R, Marçal Mariana, Fernandes Nicole, Silva Filipa, Barbosa Pedro, Vieira Mariana, Ramos João Pedro, Duarte Raquel
Local Unit of Health Cova da Beira, Covilhã, Portugal.
These authors contributed equally.
Breathe (Sheff). 2025 Mar 18;21(1):240232. doi: 10.1183/20734735.0232-2024. eCollection 2025 Jan.
Tuberculosis (TB) remains a significant global health challenge despite ongoing control efforts, particularly in the context of drug-resistant TB (DR-TB), where treatment success rates remain low, underscoring the need for new therapeutic options. This review synthesises current evidence, since the publication of the World Health Organization guidelines in 2022, on the safety and efficacy of existing and new regimens for drug-susceptible TB (DS-TB) and DR-TB in adults and children.
A comprehensive search was performed across three databases for studies published between January 2022 and February 2024, focusing on current and new TB treatment regimens. Additional backward and forward citation searches were conducted to identify relevant literature.
35 studies were included, evaluating the efficacy, safety and economic impact of new oral regimens for DS-TB and DR-TB. Regimens based on bedaquiline or delamanid demonstrated high success rates and good tolerability. The BPaLM (bedaquiline, pretomanid, linezolid and moxifloxacin) regimen was more effective and safer than the standard care, while shorter DR-TB regimens reduced costs and increased success rates. However, shorter regimens for DS-TB were associated with increased drug costs. Though limited, paediatric studies suggest that shorter, safer regimens may benefit children.
Evidence supports the adoption of shorter treatment regimens for both DR-TB and DS-TB to improve safety, effectiveness and cost-effectiveness, particularly in resource-limited settings.
尽管一直在努力控制，但结核病（TB）仍然是一项重大的全球卫生挑战，尤其是在耐多药结核病（DR-TB）方面，其治疗成功率仍然很低，这突出表明需要新的治疗选择。本综述综合了自世界卫生组织2022年指南发布以来，关于成人和儿童药物敏感结核病（DS-TB）和耐多药结核病现有和新治疗方案的安全性和有效性的现有证据。
对三个数据库进行了全面检索，以查找2022年1月至2024年2月期间发表的研究，重点是当前和新的结核病治疗方案。还进行了额外的前后引文检索，以识别相关文献。
纳入了35项研究，评估了DS-TB和DR-TB新口服方案的疗效、安全性和经济影响。基于贝达喹啉或地拉曼德的方案显示出高成功率和良好的耐受性。BPaLM（贝达喹啉、普瑞玛尼、利奈唑胺和莫西沙星）方案比标准治疗更有效、更安全，而较短的DR-TB方案降低了成本并提高了成功率。然而，DS-TB的较短方案与药物成本增加有关。虽然儿科研究有限，但表明较短、更安全的方案可能对儿童有益。
有证据支持对DR-TB和DS-TB均采用较短的治疗方案，以提高安全性、有效性和成本效益，特别是在资源有限的环境中。
