TUBERCULOSIS (TB) precision medicine may shorten therapy by using clinical phenotypes to guide stratified treatment with monitoring.
Why Clinical Phenotypes Matter in Tuberculosis Care
Despite decades of progress, TB treatment typically remains 4–6 months once disease is diagnosed. This perspective argues that one barrier to shorter regimens is the lack of a standardized way to classify disease severity before treatment begins. Today, clinicians often rely on relatively crude markers such as lung cavities on chest imaging and bacillary burden on smear microscopy, particularly in pulmonary TB.
The authors propose shifting toward a fuller clinical phenotype, integrating patient characteristics, radiological extent of disease, mycobacterial burden, drug susceptibility, and host response. They highlight how newer biomarkers, including blood-based transcriptomic and proteomic signatures, could strengthen initial stratification but are not yet routinely applied in real-world settings.
Tuberculosis Precision Medicine Starts With Phenotypes
According to the authors, shorter regimens require better alignment between the patient’s starting phenotype and the intensity and duration of therapy. They describe how “omics,” model-informed precision dosing, and integrated algorithms supported by artificial intelligence could ultimately improve classification for stratified treatment. However, these tools still need adaptation and validation through clinical trials before broad implementation.
Importantly, the approach is positioned as feasible in high-endemic settings, provided tools are practical and monitoring strategies are streamlined.
Monitoring Could Enable Safer Shorter Regimens
Once treatment begins, the authors emphasize that response monitoring should be as individualized as baseline classification. They outline a future pathway where clinicians track progress through quantification of bacterial load, radiological assessment, symptom scoring tools, and emerging transcriptomic and epigenetic biosignatures that may support sputum-free monitoring.
They also discuss therapeutic drug monitoring supported by early model-informed precision dosing, including the potential use of noninvasive samples such as urine and saliva. In this model, early monitoring enables timely drug adjustments to accelerate bacterial clearance, limit resistance development, and improve the likelihood of relapse-free cure, particularly as short-course TB treatment strategies evolve.
Reference: Niward K et al. Future Prospects for Using Clinical Phenotypes in Tuberculosis Precision Medicine—An Approach for Clinical Management. Clinical Infectious Diseases. 2026; doi:10.1093/cid/ciaf663.
