Bedaquiline Activity against Leprosy

Leprosy, caused by Mycobacterium leprae, remains a public health challenge, with treatment limited by drug resistance and side effects. In the open-label BDQ4LEP clinical trial in Bamako, Mali, we evaluated the bactericidal efficacy of bedaquiline in 30 patients with untreated multibacillary leprosy. Patients received bedaquiline for 8 weeks, followed by standard multidrug therapy for one year. Skin biopsies were analyzed for microbiologic and molecular markers. Bedaquiline treatment led to significant reductions in bacillary and molecular viability indices, with 96% culture negativity by day 56. No relapses occurred during one-year follow-up. These results suggest bedaquiline is a promising candidate for shortening and improving leprosy treatment.