On 16 July 2025, The Lancet Respiratory Medicine published the results of the Phase III endTB‑Q study, the first clinical trial to focus exclusively on pre‑extensively drug‑resistant tuberculosis (pre‑XDR‑TB).
Conducted across six countries in Asia, Africa, and South America and co‑led by global health experts, the trial compared:
- A short, personalized 6‑ or 9‑month oral regimen (bedaquiline, delamanid, clofazimine, linezolid)
- Versus a standard, longer 18–24‑month regimen using four to six drugs
The shorter regimen achieved a favorable outcome in 87% of cases, compared to 89% with the longer therapy. Notably, among patients with less extensive lung disease, the shortened 6‑month regimen was 93% effective. However, those with more advanced disease had better outcomes with the longer course, suggesting that treatment should be tailored to disease severity.
Study authors emphasize that while shorter regimens offer promise—reducing toxicity, pill burden, and costs—they are not suitable for all. Further work is needed to refine treatment strategies and adapt guidelines to ensure optimal individualized care .
This landmark study supports evolving WHO and international expert recommendations toward stratified treatment strategies in resistant TB, marking an important milestone in global TB control efforts.
