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Mumbai, May 15, 2025 – In a significant breakthrough for tuberculosis (TB) treatment, select patients in Mumbai diagnosed with drug-resistant TB (DR-TB) are now receiving a new, shorter regimen that promises improved outcomes and fewer side effects. The innovative six-month course, known as BPaLM, is being administered to over 100 patients aged 14 and above, marking a hopeful shift in the fight against one of India’s most persistent health challenges.
What is BPaLM?
BPaLM is a four-drug combination therapy comprising bedaquiline, pretomanid, linezolid, and moxifloxacin. Approved in India last year, this regimen is designed to replace the older, more taxing 18-month course, which required up to seven drugs and was often associated with severe side effects.
While patients are under the care of private chest physicians, they remain linked to municipal health centers, as bedaquiline is only available through government channels. Another 44 patients are currently receiving BPaLM at JJ Hospital, which began offering the treatment in December 2024.
Encouraging Early Results
Dr. Priti Meshram, Head of Pulmonary Medicine at JJ Hospital, emphasized that only carefully selected patients are eligible for BPaLM, in line with national guidelines. “Patients with disseminated TB, where the infection spreads beyond the lungs, are not put on this regimen due to a higher risk of relapse,” Dr. Meshram said, highlighting the extensive screening process involved.
Most side effects reported so far have been mild, such as nausea and vomiting. However, rare cases have occurred, including hepatitis in a 15-year-old patient and peripheral neuropathy in others. “The regimen isn’t weight-adjusted, so low-BMI individuals receive the same dose as heavier patients, which may contribute to rare side effects,” Dr. Meshram noted.
A Safer, More Effective Approach
Doctors describe BPaLM as significantly safer than the older regimen. Dr. Chetan Jain, a pulmonologist treating around 40 patients with BPaLM, remarked, “Side effects we’re seeing in BPaLM are nothing compared to those in the longer regimen – psychosis, even skin discolouration.”
Dr. Vikas Oswal, who led the Mumbai arm of the BPaLM clinical trial in 2021, shared that all 60 of his patients on the regimen are doing well, with major complications being rare and manageable. “Live TB bacteria are not visible in lab tests after just four weeks. This has never happened before,” he said, adding that radiological improvements are often visible within one to one-and-a-half months.
Limited Uptake Despite Training
Despite most city pulmonologists being trained to administer BPaLM, only a handful are currently placing patients on the treatment. The reasons for this limited uptake remain unclear, as key municipal health officials were unavailable for comment.
Looking Ahead
With over 1,000 patients nationwide now on the BPaLM regimen, experts are hopeful that this shorter, safer, and more effective treatment will soon become the standard of care for drug-resistant TB across India.
Disclaimer:
This article is based on information sourced from the Times of India article titled “New, shorter regimen for drug-resistant TB offers hope” (published May 2025). The details provided are for informational purposes only and should not be considered medical advice. For diagnosis or treatment of TB or any other medical condition, please consult a qualified healthcare professional.
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