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@article{Malherbe:2026:10.1126/scitranslmed.adt5626,
author = {Malherbe, ST and Chen, RY and Yu, X and Smith, B and Liu, X and Gao, J and Diacon, AH and Dawson, R and Tameris, M and Zhu, H and Qu, Y and Jin, H and Pan, S and Dodd, LE and Wang, J and Goldfeder, LC and Cai, Y and Arora, K and Vincent, J and Narunsky, K and Serole, K and Goliath, RT and Da, Costa L and Taliep, A and Aziz, S and Daroowala, R and Thienemann, F and Mukasa, S and Court, R and Sossen, B and Ahlers, P and Mendelsohn, SC and White, L and Gouel, A and Lau, C-Y and Hassan, S and Liang, L and Duan, H and Moghaddam, GK and Paripati, P and Lahouar, S and Harris, M and Wollenberg, K and Jeffrey, B and Tartakovsky, M and Rosenthal, A and Duvenhage, M and Armstrong, DT and Song, T and Winter, J and Gao, Q and Via, LE and Wilkinson, RJ and Walzl, G and Barry, CE},
doi = {10.1126/scitranslmed.adt5626},
journal = {Sci Transl Med},
title = {Clinical testing of drug treatment shortening in patients with TB using PET/CT imaging of lung lesions.},
url = {http://dx.doi.org/10.1126/scitranslmed.adt5626},
volume = {18},
year = {2026}
}
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TY  - JOUR
AB  - Six months of drug treatment is standard of care for drug-sensitive pulmonary tuberculosis (TB). Understanding the factors determining the length of treatment required for durable cure would allow individualization of treatment durations. We conducted a prospective, randomized, controlled noninferiority trial (PredictTB) of 4 versus 6 months of chemotherapy in patients with pulmonary TB in South Africa and China. Seven hundred and four participants with newly diagnosed, drug-sensitive TB were enrolled and stratified on the basis of radiographic disease characteristics assessed by FDG PET/CT imaging. Participants with less extensive disease (n = 273) were randomly assigned at week 16 to complete therapy after 4 months or continue receiving treatment for 6 months. This study was stopped early after an interim analysis revealed that patients assigned to the 4-month treatment arm had a higher risk of relapse. Among participants who received 4 months of chemotherapy, 17 of 141 (12.1%) experienced TB-specific unfavorable outcomes compared with only 2 of 132 (1.5%) who completed 6 months of treatment. In the nonrandomized arm that included participants with more extensive disease, only 8 of 248 (3.2%) experienced unfavorable outcomes. Total lung cavity volume and lesion glycolysis at week 16 were associated with the risk of unfavorable outcomes. PET/CT imaging at TB recurrence showed that bacteriological relapses predominantly occurred in active cavities originally present at baseline. Subsequent post hoc automated segmentation of serial PET/CT scans combined with machine learning enabled the classification of participants according to their likelihood of relapse.
AU  - Malherbe,ST
AU  - Chen,RY
AU  - Yu,X
AU  - Smith,B
AU  - Liu,X
AU  - Gao,J
AU  - Diacon,AH
AU  - Dawson,R
AU  - Tameris,M
AU  - Zhu,H
AU  - Qu,Y
AU  - Jin,H
AU  - Pan,S
AU  - Dodd,LE
AU  - Wang,J
AU  - Goldfeder,LC
AU  - Cai,Y
AU  - Arora,K
AU  - Vincent,J
AU  - Narunsky,K
AU  - Serole,K
AU  - Goliath,RT
AU  - Da,Costa L
AU  - Taliep,A
AU  - Aziz,S
AU  - Daroowala,R
AU  - Thienemann,F
AU  - Mukasa,S
AU  - Court,R
AU  - Sossen,B
AU  - Ahlers,P
AU  - Mendelsohn,SC
AU  - White,L
AU  - Gouel,A
AU  - Lau,C-Y
AU  - Hassan,S
AU  - Liang,L
AU  - Duan,H
AU  - Moghaddam,GK
AU  - Paripati,P
AU  - Lahouar,S
AU  - Harris,M
AU  - Wollenberg,K
AU  - Jeffrey,B
AU  - Tartakovsky,M
AU  - Rosenthal,A
AU  - Duvenhage,M
AU  - Armstrong,DT
AU  - Song,T
AU  - Winter,J
AU  - Gao,Q
AU  - Via,LE
AU  - Wilkinson,RJ
AU  - Walzl,G
AU  - Barry,CE
DO  - 10.1126/scitranslmed.adt5626
PY  - 2026///
TI  - Clinical testing of drug treatment shortening in patients with TB using PET/CT imaging of lung lesions.
T2  - Sci Transl Med
UR  - http://dx.doi.org/10.1126/scitranslmed.adt5626
UR  - https://www.ncbi.nlm.nih.gov/pubmed/41499522
VL  - 18
ER  -
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