Accelerating DR-TB Care in ASEAN Through Novel Regimens

        Asean4TB, 2025 — Drug-resistant TB remains a major challenge across Southeast Asia, where several countries continue to report high burdens of rifampicin-resistant and multidrug-resistant TB. Long, toxic regimens have historically limited treatment completion, making shorter options urgently needed. The introduction of BPaL and BPaLM offers a major turning point for DR-TB care in the region.

       BPaL (bedaquiline–pretomanid–linezolid) and BPaLM (BPaL plus moxifloxacin) are 6-month, all-oral regimens that have shown cure rates above 85–90%, significantly outperforming older 18–24-month regimens. WHO recommends these regimens as preferred options for eligible DR-TB patients. Their shorter duration and improved tolerability make them especially relevant for high-burden ASEAN countries.

    Across the region, implementation has begun to take shape. Indonesia and the Philippines are expanding access to BPaL/M in high-case districts, while Viet Nam and Thailand are generating operational evidence to guide nationwide adoption. Early lessons focus on toxicity monitoring, supply chain readiness, and strengthening pharmacovigilance systems to ensure safe rollout.

     To accelerate scale-up, ASEAN countries will need coordinated procurement pathways, harmonized clinical guidelines, and stronger patient support systems. Platforms such as ASEAN4TB can help consolidate safety data, support regional learning, and promote equitable access. Through shared action, ASEAN can rapidly advance BPaL/M adoption and strengthen DR-TB outcomes across the region.

References:

1. World Health Organization. WHO Consolidated Guidelines on Tuberculosis: Module 4 – Drug-Resistant TB Treatment. Geneva: WHO; 2022.

2. Conradie F, et al. Treatment of highly drug-resistant pulmonary tuberculosis with BPaL/BPaLM regimens. N Engl J Med. 2022.

3. World Health Organization. Global Tuberculosis Report 2025. Geneva: WHO; 2025.