Shortening Tuberculosis Treatment — A Strategic Retreat

   This editorial discusses the TRUNCATE-TB trial, which tested a strategic approach to shortening treatment for rifampin-susceptible tuberculosis. Participants were randomized to receive either standard 24-week treatment or intensified 8-week regimens (rifampin–linezolid or bedaquiline–linezolid combinations). The bedaquiline–linezolid strategy met noninferiority criteria, with most patients completing treatment in 8 weeks and low relapse and resistance rates. The article examines the design, outcomes, and toxicity concerns for bedaquiline and linezolid. It highlights the trial’s adaptive design as a model for testing future regimens and considers implementation challenges, including adherence and infrastructure needs. Authors argue that treatment “strategies” may offer more flexibility than fixed regimens, especially in lower-resource settings.

   This editorial discusses the TRUNCATE-TB trial, which tested a strategic approach to shortening treatment for rifampin-susceptible tuberculosis. Participants were randomized to receive either standard 24-week treatment or intensified 8-week regimens (rifampin–linezolid or bedaquiline–linezolid combinations). The bedaquiline–linezolid strategy met noninferiority criteria, with most patients completing treatment in 8 weeks and low relapse and resistance rates. The article examines the design, outcomes, and toxicity concerns for bedaquiline and linezolid. It highlights the trial’s adaptive design as a model for testing future regimens and considers implementation challenges, including adherence and infrastructure needs. Authors argue that treatment “strategies” may offer more flexibility than fixed regimens, especially in lower-resource settings.