ATUALIZAÇÃO NO TRATAMENTO DA TUBERCULOSE SENSÍVEL

evidências e aplicabilidade dos novos esquemas terapêuticos encurtados

Abstract

Tuberculosis remains one of the leading causes of death from infectious agents worldwide, affecting more than 10 million people annually. Although preventable and curable, the standard six-month treatment for drug-susceptible tuberculosis poses adherence challenges and may lead to unfavorable outcomes, including the development of resistance. In this context, the development of shortened therapeutic regimens has been a longstanding goal in tuberculosis management. Recently published clinical trials have demonstrated favorable results with four-month regimens, paving the way for their incorporation into international guidelines. For adults and adolescents over 12 years of age, the four-month regimen with rifapentine, isoniazid, pyrazinamide, and moxifloxacin (2HPZM/2HPM) demonstrated non-inferiority to standard treatment in Study 31, and is recommended by the WHO for cases of microbiologically confirmed pulmonary tuberculosis with susceptibility to the regimen’s drugs. For children and adolescents between 3 months and 16 years of age with non-severe forms of tuberculosis, the SHINE study demonstrated that the four-month regimen (2RHZ(E)/2RH) is non-inferior to the six-month standard, with lower cost and good adherence, having been incorporated by the Brazilian Ministry of Health in 2024. Despite these advances, implementation faces barriers such as limited availability of rifapentine, the absence of complete fixed-dose combinations, and the need for adequate diagnostic infrastructure. In Brazil, the shortened regimen for adults is not yet available through the SUS (Unified Health System), with the six-month basic regimen remaining the universal standard for drug-susceptible TB.