Multidrug-resistant Tuberculosis Treatment Outcomes:  High Success Rates of The BPaL Regimen Across Diverse Resistance Profiles In Indonesia

Heidy Agustina; Abdullah  Antaria; Erlina Burhan; Fathiyah  Isbaniyah; RR Diah Handayani; Ratnawati Ratnawati

doi:10.36497/respirsci.v7i1.246

Authors

Heidy Agustina Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan Hospital, Jakarta
Abdullah Antaria Jakarta Health Polytechnic I, Ministry of Health Republic of Indonesia, Jakarta
Erlina Burhan Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan Hospital, Jakarta
Fathiyah Isbaniyah Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan Hospital, Jakarta
RR Diah Handayani Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan Hospital, Jakarta
Ratnawati Ratnawati Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan Hospital, Jaka

DOI:

https://doi.org/10.36497/respirsci.v7i1.246

Keywords:

BPaL, efficacy, Indonesia, MDR-TB, safety

Abstract

Background: Multidrug-resistant tuberculosis (MDR-TB) remains a public health challenge in Indonesia, with 29,600 annual cases and conventional regimens achieving only 59% success. The Bedaquiline-Pretomanid-Linezolid (BPaL) regimen, which is a six-month all-oral treatment endorsed by the World Health Organization (WHO), offers a potential solution. Yet, real-world evidence in high-burden settings is limited. This study aims to assess the clinical efficacy and safety of the BPaL regimen across MDR-TB profiles in Indonesia.

Method: This retrospective cohort study conducted at Persahabatan Hospital, Jakarta (2021–2024), included 84 patients receiving the BPaL regimen and diagnosed via GeneXpert MTB/RIF or culture. Differences in treatment outcomes based on drug-resistance profiles were assessed using Fisher's exact test. Exploratory comparisons with historical-control success rates were performed using two-sided exact binomial tests.

Results: Treatment success was achieved in 77.4% of all patients. Among patients with drug-resistance profiles, success rates were 84.2% for RR-TB, 75.0% for MDR-TB, and 75.0% for pre-XDR-TB, with no significant between-profile difference (P=0.596). Overall success was higher than the 59% historical-control benchmark (P<0.001). Adverse events occurred in 28.6% of patients, primarily peripheral neuropathy (17.9%) and anemia (10.7%). Sputum conversion was observed in 85.7% of patients by the third month of treatment.

Conclusion: The BPaL regimen was associated with a high observed treatment-success rate and an acceptable safety profile in this real-world cohort. RR-TB showed the highest success rate, although treatment success did not differ significantly with drug-resistance profiles. These findings support continued programmatic use and evaluation of BPaL in Indonesia.