P-1303. Traditional 6 months Vs Shorter Duration Treatment Regimen for Drug Susceptible Tuberculosis: A Systematic Review and Meta-Analysis with Subgroup Analysis

TL;DR

This study compares shorter tuberculosis treatment regimens to the standard 6-month therapy, finding they may be just as safe and effective with fewer relapses.

Contribution

The study provides a meta-analysis showing shorter regimens reduce relapse and unfavorable outcomes without increasing mortality.

Findings

Shorter regimens significantly reduced relapse and unfavorable outcomes.

No significant differences were found in mortality, treatment completion, or adverse events.

High heterogeneity suggests variability in treatment protocols and outcomes.

Abstract

Despite the recent advances in TB, the standard 6-month regimen for drug-susceptible TB poses challenges both in adherance and development of drug resistance. Shorter regimens may be a similarly effective alternative with improved compliance and reduced toxicity. This Systematic Review and Meta-Analysis evaluates the efficacy, safety, and completion rates of such regimens versus traditional six months therapy.

A systematic search of PubMed, Embase, Scopus, and Cochrane Library identified Randomized Controlled Trials (RCTs) comparing 6 months regimen with shorter duration regimens in drug susceptible TB through March 2025. Data were analyzed using RevMan 4.2.1. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using Mantel-Haenszel methods. Random- or fixed-effects models were applied based on heterogeneity (Higgins’ I²). Statistical significance was set at p < 0.05. Risk of bias was assessed using RoB 2.0.

Fourteen RCTs (N = 10,555) were included. Shorter or novel regimens significantly reduced unfavorable outcomes (RR = 1.07; 95% CI: 0.90–1.26; p = 0.04) and relapse (RR = 2.35; 95% CI: 1.17–4.70; p = 0.02). No significant difference was observed in sputum culture conversion at 2 months (RR = 1.05; p = 0.48; I² = 96%), treatment completion (RR = 1.00; p = 0.77; I² = 61%), mortality (RR = 0.90; p = 0.60; I² = 0%), loss to follow-up (RR = 0.88; p = 0.39; I² = 57%), recurrence (RR = 1.53; p = 0.15; I² = 73%), or adverse events (RR = 1.07; p = 0.45; I² = 77%). Subgroup analyses also showed variable heterogeneity across outcomes.

The Short novel regimens may reduce relapse and unfavorable outcomes without increasing mortality but there is high heterogeneity. Observed heterogeneity is likely due to variation in treatment duration, drug regimens, variations in control groups and local antibiotic resistance. Findings support shorter regimens as viable alternatives, but further head-to-head trials are needed to bring a change in the global clinical practice.

All Authors: No reported disclosures