ABSTRACT:
The World Health Organization (WHO) has issued updated recommendations for the treatment of drug-resistant tuberculosis (DR-TB) using a shorter regimen (6 months) consisting of bedaquiline, pretomanid, and linezolid, with or without moxifloxacin (BPaL/BPaLM). The aim of this study was to comprehensively analyze the safety and effectiveness of the BPaL/BPaLM regimen in patients with DR-TB. A literature search was conducted using the PubMed, Cochrane Library, ProQuest, and Google Scholar databases. This systematic review was conducted in accordance with the PRISMA guidelines. The search terms included ("tuberculosis" OR "TB" OR "drug-resistant tuberculosis" OR "DR-TB" OR "multidrug-resistant tuberculosis" OR "MDR-TB" OR "pre-extensively drug-resistant tuberculosis" OR "pre-XDR-TB" OR "extensively drug-resistant tuberculosis" OR "XDR-TB") AND ("BPaL" OR "BPaLM" OR "bedaquiline" OR "pretomanid" OR "linezolid" OR "moxifloxacin") AND ("effectiveness" OR "efficacy") AND ("safety" OR "adverse events"). A total of 2508 articles were identified from the published literature, of which 11 were included in this systematic review. Treatment success with the BPaL regimen ranged from 77.0% to 97.6%, whereas success with the BPaLM regimen ranged from 89.0% to 95.5%. A linezolid dose of 1200mg was associated with a higher frequency of adverse events compared with doses of 600mg and 300mg, including peripheral neuropathy, myelosuppression, optic neuropathy, elevated liver enzymes, and QTc interval prolongation. Therefore, regular monitoring for adverse events is recommended when determining the optimal linezolid dose and throughout treatment for DR-TB treatment. The BPaL/BPaLM regimen represents a recent innovation that has demonstrated effectiveness in the treatment of DR-TB and is expected to contribute to improving the success of tuberculosis control programs worldwide.