A promising study presented at The Union World Conference on Lung Health 2022, the TRUNCATE TB trial, has revealed that some people who have TB can be treated in as little as two months, as opposed to six months of treatment that has been the standard of care in most countries since the 1980s.
The rationale behind the TRUNCATE TB study, according to Erlina Burhan, a TB expert from the Faculty of Medicine Univeritas Indonesia, is that we are overtreating majority of people who have drug-susceptible TB (DS-TB) who would actually be cured before the 6-month mark, to prevent relapse in a minority of people who would need the long treatment regimen. This eye-opening study has revealed that the standard six-month treatment is actually over-treating a lot of people who have TB, which is the world’s leading infectious killer.
The TRUNCATE-TB Trial is a randomised controlled trial conducted at 18 sites in five countries (Indonesia, the Philippines, Thailand, India and Uganda) and coordinated from Singapore. The trial investigates a treatment strategy comprising an initial 2-month treatment course (using regimens combining standard and repurposed drugs intended to boost regimen sterilising efficacy), followed by close monitoring and early retreatment of relapses. A total of 674 trial participants were recruited from March 2018 to March 2022 from these 5 countries.
Trial participants were initially given eight weeks of treatment, with the option of extending treatment to 10 to 12 weeks if they had persistent clinical disease after the eight-week treatment. If there was still active TB after that, participants were switched to the standard six-month treatment. It was noted that overall death rate was low and there was no difference in the death rate between the standard treatment arm and the TRUNCATE strategy arms.
