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

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.