India has begun implementing a groundbreaking shorter treatment regimen for drug-resistant tuberculosis (DR-TB), offering new hope to thousands of patients who previously faced lengthy and difficult treatment journeys.
The six-month BPaLM regimen—consisting of bedaquiline, pretomanid, linezolid, and moxifloxacin—is now being administered to carefully selected patients across multiple centers in the country after receiving approval from the Union Health Ministry in September 2023.
Treatment Implementation Progress
In Mumbai, approximately 100 patients under private chest physicians' care have started the BPaLM regimen, with an additional 44 patients being treated at JJ Hospital, which began offering the treatment in December. Nationwide, over 1,000 patients are currently receiving this innovative therapy.
"We are administering BPaLM to carefully selected patients in line with national guidelines," said Dr. Priti Meshram, Head of Pulmonary Medicine at JJ Hospital. She emphasized that patient selection is critical, noting that individuals with disseminated TB—where infection spreads beyond the lungs to other organs—are not eligible for this treatment due to a higher risk of relapse.
The state government of Odisha has also rolled out the BPaLM regimen in three medical colleges: MKCG Medical College and Hospital in Berhampur, SCB Medical College and Hospital in Cuttack, and PRM Medical College and Hospital in Baripada. Dr. Priyanka Das, associate professor and head of the pulmonary medicine department at MKCG Medical College, confirmed that they have already treated five patients under the new regimen in just three days.
Clinical Advantages and Outcomes
The new regimen represents a dramatic improvement over conventional DR-TB treatments, which typically last between 9 months and two years and involve up to seven different medications. Doctors report that BPaLM is showing remarkable early results.
Dr. Vikas Oswal, a pulmonologist who led the Mumbai arm of the BPaLM clinical trial in 2021 and has since enrolled 60 patients, noted an unprecedented treatment response: "Live TB bacteria is not visible in lab tests in just four weeks. This has never happened before. Radiological changes are visible in one to one-and-half months."
This rapid bacterial clearance suggests potentially higher cure rates and reduced transmission periods, which could have significant public health implications in India's fight against tuberculosis.
Safety Profile and Side Effects
While the BPaLM regimen has demonstrated a more favorable safety profile compared to traditional DR-TB treatments, monitoring for side effects remains important. Most patients experience only mild adverse events such as nausea and vomiting, though rare cases of more serious complications have been documented.
Dr. Meshram noted one case of a 15-year-old who developed hepatitis, and mentioned that peripheral neuropathy is another known side effect. "The regimen isn't weight-adjusted. Low-BMI individuals receive the same dose as relatively heavier patients, which may lead to rare side effects," she explained.
Despite these concerns, physicians overwhelmingly report that BPaLM's side effect profile is substantially better than the longer regimen. Dr. Chetan Jain, a pulmonologist treating around 40 patients with BPaLM in Vikhroli, Ghatkopar, and Kurla areas of Mumbai, stated: "Side-effects we're seeing in BPaLM are nothing compared to those in the longer regimen—psychosis, even skin discolouration."
Treatment Access and Coordination
An interesting aspect of the BPaLM implementation is the coordination between private practitioners and government health facilities. Patients under private care remain linked to municipal health centers because bedaquiline, one of the four drugs in the regimen, is available only through government channels.
This public-private partnership model may help expand access to this innovative treatment while ensuring proper monitoring and adherence to national guidelines.
Public Health Significance
The introduction of BPaLM is particularly significant in regions with high TB burdens. In Ganjam district, where MKCG Medical College is located, tuberculosis continues to be a major health challenge with over 200 reported deaths annually. The district detected 6,535 new cases in 2024, comparable to 6,698 and 6,466 new cases in 2023 and 2022, respectively.
The implementation of this shorter, more effective regimen could substantially impact these numbers by improving treatment adherence, reducing the development of further drug resistance, and decreasing the overall burden of DR-TB in high-prevalence communities.
Future Outlook
As more healthcare facilities across India begin implementing the BPaLM regimen, careful monitoring of outcomes and side effects will be crucial. The initial positive results suggest that this shorter treatment approach could become the standard of care for eligible DR-TB patients, potentially transforming the management of drug-resistant tuberculosis in India and beyond.
The successful rollout of BPaLM represents a significant step forward in India's National TB Elimination Programme (NTEP) and offers renewed hope in the global fight against drug-resistant tuberculosis.
