Annual progress in chemotherapy for tuberculosis in 2025
Abstract
In recent years, substantial progress in the development of anti-tuberculosis (TB) drugs and treatment strategies has accelerated the transition of TB chemotherapy toward shorter-course, all-oral, and increasingly individualized regimens. Over the past year, short-course rifamycin-containing preventive therapies (1HP, 3HP, and 4R) have consistently demonstrated high adherence and favorable safety across diverse populations. In addition, fluoroquinolone-based regimens for contacts of multidrug-resistant TB have gained strong evidence-based support. In the therapeutic domain, multiple phase Ⅱ and Ⅲ trials have further validated the clinical value of novel mechanisms and optimized combinations. New agents such as Telacebec, Quabodepistat, Sutezolid, and Delpazolid exhibit potent bactericidal activity and lower toxicity, laying the foundation for regimen shortening and combination optimization. The BPaL/BPaLM regimens have achieved high cure rates, rapid culture conversion, and good tolerability in real-world studies across several countries. In addition, 9-month (Bedaquiline-Linezolid-Fluoroquinolone-based) and 6-9-month all-oral regimens with varied combinations have shown comparable efficacy across different resistance patterns and resource settings, providing feasible alternatives in regions where Pretomanid availability is limited. For drug-susceptible pulmonary TB, the 4-month rifapentine-moxifloxacin regimen (2HPZM/2HPM) has been endorsed in recent clinical guidelines.…
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