BPaL(M) Regimen for the Treatment of MDR/RR-TB

The BPaL (Bedaquiline, Pretomanid, Linezolid) regimen has been proven effective for the treatment of Fluoroquinolone-resistant MDR-TB through studies such as the NixTB and ZeNix trials. In addition, the BPaLM regimen has been demonstrated to have excellent efficacy in RR-TB patients through the TB-PRACTECAL study. This study aims to analyze the efficacy of the BPaL(M) regimen in Korean MDR/RR-TB patients.

Inclusion criteria

• At least 19 years old at enrolment
• Bodyweight over 35Kg
• If rifampicin resistance is confirmed through molecular or phenotypic drug susceptibility testing conducted on sputum or bronchoscopy specimens within 3 months of screening
• Chest radiological findings consistent with pulmonary tuberculosis

Exclusion criteria

• Uncontrolled DM
• Extrapulmonary TB that would require treatment longer than would be usual for pulmonary TB
• Less than 30 Karnofsky score at enrolment
• BMI less than 17
• Known severe allergy to any of the BPaLM regimen drugs
• Medical history of Glucose-galactose malabsorption, galactose intolerance, and Lapp lactase deficiency
• HIV-positive
• The QTcF interval exceeds 450 msec on the electrocardiogram at baseline
• Patients who are at risk of Torsade de Pointes due to underlying heart diseases such as heart failure or arrhythmia
• For women of childbearing potential if the pregnancy test is positive, women who are breastfeeding or planning to become pregnant within 6 months of discontinuation/termination of treatment during the study, or who do not want contraception (i.e., oral and subcutaneous hormonal contraceptives, condoms, diaphragms, intrauterine device, or use of appropriate contraceptive methods including abstinence)

*Note: Double contraception (e.g., when a male uses a barrier contraceptive method such as a condom, a female partner uses a hormonal contraceptive or an additional contraceptive method such as an intrauterine device) is required while taking the study drug and up to 6 months after stopping/terminating the study drug. In particular, taking the study drug may affect the efficacy of hormonal contraceptives, and even if you are using only barrier contraception at the same time with your partner, you cannot be sure of preventing pregnancy, so it is necessary to maintain double contraception.

• Men who plan to become pregnant during the study period or within 6 months of discontinuation/termination of treatment, or who do not wish to use double contraception or abstinence during this period.
• Patients who have Grade 3 or 4 or higher peripheral neuritis, or Grade 1 or 2 with a high probability of progression to peripheral neuritis,
• Current use of monoamine oxidase Inhibitor or used 2 weeks before treatment
• Use of serotonergic antidepressant within 3 days of treatment
• Any contraindication that may affect QTc interval (amiodarone, chloroquine, chlorpromazine, clarithromycin, haloperidol, etc.)
• Any contraindication that may cause myelosuppression
• Taking drugs that affect the cytochrome P450 enzyme within 30 days (quinidine, tyramine, ketoconazole, fluconazole, testosterone, quinine, gestodene, metyrapone, phenelzine, doxorubicin, troleandomycin, cyclobenzaprine, erythromycin, cocaine, furafylline, cimetidine, dextromethorphan, etc.)
• Previously treated with Bedaquiline or Linezolid for more than 4 weeks
• Abnormal value of a blood test at baseline:

• Hypokalemia, Hemoglobin < 8.0 g/dL, Platelet < 75,000/mm3, ANC < 1000/mm3
• AST or ALT > 3 X ULN, Total bilirubin >2.0 X ULN, Albumin < 3.2 mg/dL
• Serum creatinine > 2 X ULN, Serum calcium < LLN, Serum magnesium < LLN