For the first time, select patients in the city with drug-resistant tuberculosis (DR-TB) are receiving a shorter and more effective treatment regimen. As of Wednesday, 100 patients aged above 14 have started a six-month course of BPaLM, a four-drug combination therapy approved in India last year. This shift marks a significant improvement in the management of DR-TB, offering fewer side-effects and better outcomes.
BPaLM Regimen: A New Hope
As reported by TOI, the BPaLM regimen includes bedaquiline, pretomanid, linezolid, and moxifloxacin. While private chest physicians are overseeing treatment, patients remain linked to municipal health centres because bedaquiline is available only through government channels.
Public Hospitals Join In
In addition to the 100 patients under private care, JJ Hospital has enrolled another 44 patients since December. Nationally, over 1,000 patients are currently receiving the BPaLM regimen. Dr. Priti Meshram, Head of Pulmonary Medicine at JJ Hospital, confirmed, “We are administering BPaLM to carefully selected patients in line with national guidelines.”
Careful Selection to Minimize Risk
However, not all DR-TB patients are eligible. Those with disseminated TB—where the infection has spread beyond the lungs—are excluded due to a higher risk of relapse. “We conduct extensive screening to ensure only suitable candidates are placed on the regimen,” Dr. Meshram added.
Mild Side-Effects with Rare Complications
Most side-effects reported so far are mild, such as nausea and vomiting. However, rare complications have occurred. In one case, a 15-year-old patient developed hepatitis. Peripheral neuropathy is another known risk. Dr. Meshram pointed out a limitation of the regimen: “BPaLM isn’t weight-adjusted. Even patients with low BMI receive the same dose, which may lead to side-effects in rare cases.”
BPaLM Outperforms Older Treatment
Doctors widely regard BPaLM as safer and more tolerable than the older 18-month regimen, which uses up to seven drugs. Currently, around 64,000 DR-TB patients in India remain on this longer course. Dr. Chetan Jain, a pulmonologist managing 40 BPaLM patients across Vikhroli, Ghatkopar, and Kurla, said, “The side-effects with BPaLM are far milder compared to the older regimen, which often causes psychosis and skin discolouration.”
Clinical Trials Show Encouraging Results
Dr. Vikas Oswal, who led the Mumbai arm of the BPaLM clinical trial in 2021, has since enrolled 60 patients. “All are doing well. Major complications are rare and manageable,” he reported. Notably, he observed that live TB bacteria disappear from lab tests within just four weeks. “This has never happened before. Even radiological improvements are visible within one to one-and-a-half months,” he said.
Slow Uptake Among Trained Doctors
Despite many city pulmonologists being trained in administering BPaLM, only three doctors have begun placing patients on the new treatment. The reasons behind this slow adoption remain unclear, as both BMC’s executive health officer Dr. Daksha Shah and city TB officer Dr. Varsha Puri were unavailable for comment.
Conclusion
The rollout of BPaLM in Mumbai marks a promising shift in DR-TB treatment. With continued monitoring, better awareness, and broader implementation, this shorter regimen could revolutionize TB care across India.