In 2020, a multicountry phase III randomized controlled clinical trial demonstrated the efficacy and safety of a 4-month regimen composed of isoniazid, rifapentine, moxifloxacin, and pyrazinamide (HPMZ) for the treatment of drug-sensitive TB.
A retrospective cohort study, published in Open Forum Infectious Diseases, described early experience implementing the 4-month regimen in San Francisco in the United States. Among 22 people eligible for and initiated on the four month HPMZ regimen between August 2021 and December 2023, 11 (50%) prematurely discontinued the regimen due to mild adverse events, namely nausea, vomiting, and rash. All eight people that completed the regimen had good outcomes. This early experience underscores the importance of studying how new regimens perform outside of clinical trials and under more routine TB program conditions. Further experiences will help identify best practices for implementing the 4-month regimen, including how to identify patient groups that may benefit most and to manage mild adverse events that may affect the tolerability and acceptability of the regimen.