Updated treatment guidelines for drug-resistant TB: how safe are clofazimine-based regimens?

In June 2024, WHO released ‘Key updates to the treatment of drug-resistant tuberculosis: rapid communication’, after the preliminary publication of results from two clinical trials: ‘BEAT-Tuberculosis’ and ‘endTB’. All proposed regimens include clofazimine (Cfz). However, a recent paper has reported a high incidence of QTc prolongation among patients receiving Cfz-based treatment for multidrug-resistant TB in Taiwan. Here, we discuss the cardiac safety of Cfz and the role of active drug safety monitoring at the programme level in collecting information on this issue.