BPal, the new treatment for drug-resistant tuberculosis, it really works

Previously, the 25-year-old doctor from kyiv (Ukraine) was following another treatment: almost half as effective, involving more tablets, and which also caused him neurological side effects.

These disappeared when he switched to the new treatment, which he took for only six months, compared to two years for the previous one: “It was very easy”, Volodymyr told AFP.

A CT scan carried out yesterday showed that he no longer showed any signs of tuberculosis. He now plans to return to work next week after eight months of sick leave. “Now I can start living again”, he rejoices.

Tuberculosis, formerly known as “consumption”, was the biggest cause of infectious death before the arrival of Covid-19, with 1.5 million people dying each year.

About 5% of new cases are resistant to prescribed antibiotics, making them difficult to treat.

But a new drug regimen, called BPaL because it combines the three antibiotics bedaquiline, pretomanid and linezolid, has been seen as a major breakthrough since its approval by the US Food and Drug Administration (FDA) in 2019.

Significantly reduced side effects

Research in 2020 showed that the BPaL diet cured more than 90% of patients, but there was a high rate of linezolid-related side effects, including nerve pain or bone marrow depression.

A study published yesterday in the New England Journal of Medicine a game-changer: it demonstrates that the dosage of linezolid can be reduced by half without significantly reducing the effectiveness of the treatment.

A trial involving 181 participants with drug-resistant tuberculosis was conducted in Russia, South Africa, Georgia and Moldova – countries with high rates of tuberculosis.

It found that while 1,200 milligrams of linezolid over six months worked 93%, that rate remained at 91% when the dose was halved to 600 milligrams.

In this trial, the number of participants with peripheral neuropathy, which causes nerve pain, fell from 38% to 24%, while the rate of bone marrow suppression fell from 22% to 2%.

“This is the beginning of the end for drug-resistant tuberculosis”, the study’s lead author, Francesca Conradie, of the University of the Witwatersrand in South Africa, told AFP. “The sooner you treat someone’s TB, the less contagious they are – it’s like Covid in many ways.”

5 pills a day vs 23 pills a day so far

It is also easier for patients to take BPaL: whereas previous treatments could involve 23 pills a day and up to 14,000 pills in total over two years, BPaL consists of five pills a day – less than 750 over six months.

For Nataliia Lytvynenko, who oversaw BPaL treatments in Ukraine, the more manageable amount of pills makes it easier for patients who have been displaced by war to continue treatment.

The World Health Organization said earlier this year that it would soon update its guidelines to recommend that most patients with drug-resistant tuberculosis use BPaL with 600 milligrams of linezolid.

It is there “major advances”, pointed out two experts in the field, not involved in Wednesday’s study.

BPaL treatment “is one of the defining advances in scientific research on tuberculosis this century”, wrote Guy Thwaites of Britain’s Oxford University and Nguyen Viet Nhung of Vietnam’s National Tuberculosis Control Program in an op-ed in the New England Journal of Medicine.

These advances come at a time when the Covid pandemic had raised fears of a certain number of brakes in the fight against tuberculosis.

With AFP

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