Future-proofing tuberculosis therapy: framework for concurrent drug and resistance testing development

SummaryThe rapid emergence of resistance to novel tuberculosis drugs, such as bedaquiline, is a key threat to the long-term effectiveness of novel regimens. Given that the introduction of these agents has enabled the introduction of an all-oral regimen for rifampicin-resistant and multidrug-resistan...

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Veröffentlicht in:The Lancet infectious diseases
Hauptverfasser: Saluzzo, Francesca, MD, Yerlikaya, Seda, PhD, Dorman, Susan Elizabeth, MD, Eisenach, Kathleen, PhD, Farhat, Maha Reda, MD, Ismail, Nazir, FCPath, Lienhardt, Christian, PhD, Walker, Timothy M, Prof, Jones, Fatima, PhD, Yepes, Ana, PhD, Penn-Nicholson, Adam, PhD, Ruhwald, Morten, MD, Kana, Bavesh, PhD, Denkinger, Claudia Maria, MD, Cirillo, Daniela Maria, MD
Format: Journal Article
Sprache:Englisch
Veröffentlicht: 2025
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Infectious Disease
ISSN:1473-3099
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Abstract SummaryThe rapid emergence of resistance to novel tuberculosis drugs, such as bedaquiline, is a key threat to the long-term effectiveness of novel regimens. Given that the introduction of these agents has enabled the introduction of an all-oral regimen for rifampicin-resistant and multidrug-resistant tuberculosis, the rise of resistance underscores the urgent need to safeguard their efficacy and responsible use. A major barrier is the delay in developing reliable tools to detect resistance to novel compounds, which limits clinical decision-making and surveillance efforts. Herein, we outline a framework for integrating the development of drug susceptibility testing alongside tuberculosis drug development, including early stage resistance profiling and defining appropriate epidemiological cutoff values. We highlight key gaps, including the need for structured partnerships between drug developers, diagnostic manufacturers, regulators, research institutions, funders, and policy makers. We propose a roadmap to accelerate drug susceptibility testing and development of new tuberculosis regimens, ensuring that resistance detection maintains pace with the introduction of novel drugs. Establishing collaborative platforms for data sharing, genomic analysis, and diagnostic innovation will help ensure that resistance detection evolves in step with drug development, thereby preserving novel treatments and improving global tuberculosis care.
AbstractList SummaryThe rapid emergence of resistance to novel tuberculosis drugs, such as bedaquiline, is a key threat to the long-term effectiveness of novel regimens. Given that the introduction of these agents has enabled the introduction of an all-oral regimen for rifampicin-resistant and multidrug-resistant tuberculosis, the rise of resistance underscores the urgent need to safeguard their efficacy and responsible use. A major barrier is the delay in developing reliable tools to detect resistance to novel compounds, which limits clinical decision-making and surveillance efforts. Herein, we outline a framework for integrating the development of drug susceptibility testing alongside tuberculosis drug development, including early stage resistance profiling and defining appropriate epidemiological cutoff values. We highlight key gaps, including the need for structured partnerships between drug developers, diagnostic manufacturers, regulators, research institutions, funders, and policy makers. We propose a roadmap to accelerate drug susceptibility testing and development of new tuberculosis regimens, ensuring that resistance detection maintains pace with the introduction of novel drugs. Establishing collaborative platforms for data sharing, genomic analysis, and diagnostic innovation will help ensure that resistance detection evolves in step with drug development, thereby preserving novel treatments and improving global tuberculosis care.
Author Farhat, Maha Reda, MD
Cirillo, Daniela Maria, MD
Eisenach, Kathleen, PhD
Jones, Fatima, PhD
Penn-Nicholson, Adam, PhD
Saluzzo, Francesca, MD
Ismail, Nazir, FCPath
Denkinger, Claudia Maria, MD
Lienhardt, Christian, PhD
Walker, Timothy M, Prof
Yerlikaya, Seda, PhD
Kana, Bavesh, PhD
Dorman, Susan Elizabeth, MD
Ruhwald, Morten, MD
Yepes, Ana, PhD
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Snippet SummaryThe rapid emergence of resistance to novel tuberculosis drugs, such as bedaquiline, is a key threat to the long-term effectiveness of novel regimens....
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