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Life sciences · Journal article
The Lancet. Microbe
A consensus or society position rather than new primary data.
This narrative review synthesizes evidence from seven pivotal randomised trials conducted since 2020 that have redefined tuberculosis treatment through shorter, fully oral regimens with improved efficacy and safety, and have driven major WHO guideline updates. The underlying trial evidence supports practice-changing advances across drug-susceptible and drug-resistant tuberculosis in adults and children including people with HIV, though this abstract reports epidemiological context and drug development pipeline status rather than primary efficacy endpoints.
Narrative review. Adults and paediatric populations with drug-susceptible or drug-resistant tuberculosis, including people with HIV; also migrants and displaced populations identified as having poorest outcomes.
Seven pivotal randomised trials (TB-PRACTECAL, ZeNix, Nix-TB, endTB, BEAT-TB, SHINE, Study 31/A5349) have redefined management of drug-susceptible and drug-resistant tuberculosis since 2020 Trials have enabled shorter, fully oral regimens with improved efficacy and safety across adult and paediatric populations, including people with HIV In 2024, an estimated 10.7 million people developed tuberculosis; approximately 390,000 developed multidrug-resistant or rifampicin-resistant tuberculosis
Trials have enabled shorter, fully oral regimens with improved efficacy and safety across adult and paediatric populations, including people with HIV
Clinicians should refer to the updated WHO treatment guidelines informed by the seven cited pivotal trials for current evidence-based management of tuberculosis. The review signals that shorter, fully oral regimens are now standard of care, though specific regimen details and efficacy metrics are not provided in this abstract.
A comprehensive narrative review synthesizing pivotal trial evidence and WHO guideline updates on tuberculosis treatment innovation since 2020, without reporting new primary efficacy data.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should refer to the updated WHO treatment guidelines informed by the seven cited pivotal trials for current evidence-based management of tuberculosis. The review signals that shorter, fully oral regimens are now standard of care, though specific regimen details and efficacy metrics are not provided in this abstract.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Tuberculosis treatment has undergone its most profound transformation since the launch of the standardised DOTS strategy in 1994. Since 2020, a series of pivotal randomised trials, including TB-PRACTECAL, ZeNix, Nix-TB, endTB, BEAT-TB, SHINE, and Study 31/A5349, have redefined the management of both drug-susceptible and drug-resistant tuberculosis. These studies have enabled shorter, fully oral regimens with improved efficacy and safety across adult and paediatric populations, including people with HIV, and have driven major updates to WHO treatment guidelines. Despite these advances, tuberculosis remains the leading cause of death from a single infectious agent worldwide, with substantial mortality occurring before treatment initiation due to delayed diagnosis and pretreatment loss to follow-up, and additional deaths during treatment related to advanced disease, drug resistance, comorbidities, and challenges with treatment tolerance and adherence. In 2024, an estimated 10·7 million people developed tuberculosis of whom approximately 390 000 developed multidrug-resistant (MDR) or rifampicin-resistant (RR) tuberculosis. Tuberculosis caused an estimated 1·23 million deaths globally, including approximately 150 000 deaths attributable to MDR tuberculosis or RR tuberculosis. Outcomes remain poorest among people with HIV, young children (who rarely access treatment and prevention), migrants, and displaced populations. The tuberculosis drug development pipeline in 2026 is more advanced than at any time since the introduction of rifampicin. Novel and repurposed compounds, including DprE1 inhibitors, next-generation oxazolidinones (including TBAJ-587 and TBAJ-876), cytochrome bc1 inhibitors, and long-acting formulations, are in late-stage evaluation. Host-directed therapies are also advancing as adjunctive strategies to reduce inflammation-mediated tissue damage and long-term morbidity, although they remain investigational. This Series paper synthesises advances in adult and paediatric tuberculosis therapeutics from Nov 15, 2020, to Jan 15, 2026, and highlights priorities to translate therapeutic innovation into equitable population-level effects.
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