The Philippines enrolls first patient with highly drug-resistant TB on the BPaL regimen (acknowledgment: Dr. Irene Flores)

“I really want to get well fast, so BPaL is better for me.”

This story was originally posted by Tropical Disease foundation at tdf.org

These are the words of 36 year old lady Mary (not her real name), married with 15 year old twin sons.

She was diagnosed with TB in 2018 and given 6 months of first-line treatment. However, she later turned out rifampicin-resistant. Mary has diabetes and maintained on insulin.

She was then started on an injectable-based shorter regimen intended for 9 months. Daily, she endured the painful injections in the facility because she wanted to be cured. Four months later, her smear converted to negative which brought her much joy because that meant she could now be free of the injectable!

However, on month 5, the second-line LPA result revealed resistance to the fluoroquinolones and injectables for which she had to be given a longer regimen. She refused.

Her cough recurred a few months after stopping treatment. The pulmonologist she consulted treated her with first-line drugs for 12 months. Her symptoms worsened and she was hospitalized twice until her doctor admitted there was nothing else he could do. At this time, Mary had already developed pulmonary hypertension and right-sided heart failure. She was subsequently referred back to the Jose B Lingad Memorial General Hospital (JBLMGH) where she had her MDR treatment before. The treatment center nurse  immediately identified her as potentially eligible for BPaL, a regimen for highly drug-resistant TB patients composed of only three drugs, all-oral and given for only 6 months.

Dr. Irene Flores, Principal Investigator of the BPaL Operational Research (OR), who also serves as a physician in JBLMGH gave Mary a background of the new regimen including its risks and benefits. With renewed hope for cure with a novel treatment, Mary was motivated to start BPaL saying, "Gusto ko na po talagang gumaling agad kaya mas ok po sa akin, at tingin ko po kakayanin ko yung BPaL." [I really want to be get well fast; so, BPaL is better for me, and I think I can take it.]  She signed the consent on 31 May 2021 and the first dose was started a few days later.

SL-LPA done at the Tropical Disease Foundation confirmed Mary’s high drug resistance profile. On the first month of treatment, Mary’s smear had converted to negative. Except for mild headache, and a rash, she expressed that overall, she is happy because she feels she is getting better from her illness. She has just had her second month follow-up.

JBLMGH is one of the twelve OR sites in the Philippines and has enrolled five patients on the BPaL regimen. The OR aims to enrol 100 patients in all the 12 OR sites in the country by December 2022.   It is officially endorsed by the Department of Health with the issuance of Department Memorandum 2021-0246 “Implementation of the Pilot Study to Evaluate the Effectiveness and Safety of the Bedaquiline-Pretomanid-Linezolid (BPaL) Treatment Regimen in the Philippines.”