結核病治療新知：短程治療簡介

Update on Short-Course Treatment for Tuberculosis

結核病是全球重要公共衛生問題，對人類造成嚴重的罹病率和死亡。短程治療藉由改善病人藥囑遵從率可提升結核病人的完成治療率，改善病人治療預後，進而降低結核病的發生率及死亡率。另外，因縮短治癒時間和減少結核菌傳播、合併多種有效藥物處方治療能降低抗藥性結核菌的產生、也可減少公共衛生與醫療照護系統的負荷及醫療支出。目前結核病的短期療程發展方式，包括：調整現有藥物種類劑量達到縮短治療療程的目的(fluoroquinolones或rifamycins)，或是使用含有新藥的處方，例如pretomanid、bedaquiline以縮短處方。另一方式為stratified medicine，也就是針對低疾病嚴重度與低復發風險族群病人，例如無開洞、抗酸性染色為陰性、或兩個月痰液培養為陰性病人，縮短傳統六個月藥物處方到四個月。本文章回顧現今重要抗結核短程治療的文獻，包括：藥物敏感性結核病的TBTC 31 / A5349隨機分配臨床試驗、TRUNCATE-TB策略性治療和多重藥物抗藥性結核病的TB-PRACTECAL和ZeNiX-TB研究，後兩者使用BPaLM或BPaL regimen (bedaquiline, pretomanid, linezolid with/without moxifloxacin)。目前短程治療不論針對全敏感性結核或是多重抗藥性結核都有新的研究顯示可以縮短治療處方。短程抗結核藥物治療希望在維持療效的情況下能縮短療程，以達到改善病人預後，減少醫療支出和公共衛生體系的負荷，最終能達到結核病的控制和消除。

Tuberculosis (TB) is a significant, global public health problem, causing high morbidity and mortality. Short-course therapy can improve treatment completion rates by enhancing treatment adherence, thereby improving patient treatment outcomes and subsequently reducing the incidence and mortality of TB. Additionally, highly effective combination therapy can reduce the emergence of drug-resistant TB, shorten time to cure, thereby reduce the transmission of TB, and alleviate the burden on public health systems and healthcare systems, as well as lowering healthcare expenditures.
Current approaches to the development of shortened TB regimens include either adjusting the dosage of existing drugs such as fluoroquinolones or rifamycins, or using prescriptions containing new drugs such as pretomanid or bedaquiline. Stratified medicine targets patients with low disease severity and low risk of relapse, such as those without cavitation, negative acid-fast staining, or negative sputum cultures at two months, to shorten the traditional six-month drug regimen to four months.
This article reviews current literature on short-course TB treatment, including the TBTC 31/A5349 randomized clinical trial for drug-susceptible TB, and the TRUNCATE-TB strategic treatment. For multidrug-resistant TB, the TB- PRACTECAL study and ZeNiX-TB, using the BPaLM/BPaL regimen (bedaquiline, pretomanid, linezolid with/without moxifloxacin). Current research indicates that short-course therapy, whether for drug-sensitive or multidrug-resistant TB is effective. Short-course anti-TB drug therapy aims to shorten treatment duration while maintaining efficacy, with the goal of improving patient outcomes, reducing healthcare expenditures, and alleviating the burden on the public health system, ultimately leading to TB control and elimination.