# Effectiveness and Safety of Bedaquiline-Containing Modified Shorter Regimens for Multidrug- or Rifampicin-Resistant Tuberculosis: A Single-Arm Meta-Analysis

## TL;DR

This study evaluates modified shorter regimens containing bedaquiline for treating drug-resistant tuberculosis, finding them effective and relatively safe.

## Contribution

The study introduces modified shorter regimens with bedaquiline as a potential alternative for drug-resistant TB treatment.

## Key findings

- The pooled treatment success rate was 78.5% for modified regimens containing bedaquiline.
- Serious adverse events occurred in 10.0% of patients using these regimens.
- Modified regimens may be a viable option for patients ineligible for standardized regimens.

## Abstract

Tuberculosis (TB) remains a global public health emergency, with multidrug-resistant TB (MDR-TB) and rifampicin-resistant TB (RR-TB) posing critical challenges. Conventional longer regimens are characterized by suboptimal effectiveness, high toxicity, and poor tolerability. Consequently, there is an urgent demand for more effective, safer, shorter regimens with enhanced tolerability to replace traditional treatments. The present study aimed to systematically assess the effectiveness and safety of bedaquiline-containing modified shorter regimens (adaptations of the WHO-recommended 9–12-month bedaquiline-containing shorter regimen, with ethionamide, ethambutol, isoniazid, and pyrazinamide partially or fully substituted by linezolid, cycloserine/terizidone, and/or delamanid) for MDR/RR-TB. Databases (PubMed, Cochrane Library, Embase, and Web of Science) were searched up to 17 December 2025. Data on treatment success, adverse events, and patient characteristics were extracted. Heterogeneity was assessed using Cochrane Q test and I2 statistic. Eleven studies involving 8166 patients were included. The pooled treatment success rate was 78.5% (95% CI: 0.69~0.87, I2: 98.45%; p = 0.00). The incidence of serious adverse events was 10.0%. Bedaquiline-containing modified shorter regimens may offer a potentially viable treatment option for MDR/RR-TB patients, giving an option for patients who are ineligible for standardized regimens. In order to verify these findings, further large-scale trials are required.