New Antituberculosis Drugs: From Clinical Trial to Programmatic Use

Treatment of multidrug-resistant tuberculosis (MDR-TB) cases is challenging because it relies on second-line drugs that are less potent and more toxic than those used in the clinical management of drug-susceptible TB. Moreover, treatment outcomes for MDR-TB are generally poor compared to drug sensit...

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Bibliographic Details
Published in:Infectious Disease Reports Vol. 8; no. 2; p. 6569
Main Authors: Gualano, Gina, CAPONE, Susanna, MATTEELLI, Alberto, Palmieri, Fabrizio
Format: Journal Article
Language:English
Published: Italy MDPI AG 24.06.2016
PAGEPress Publications, Pavia, Italy
Subjects:
antituberculosis therapy
Carbapenems
Clinical outcomes
Clinical trials
Conversion
Drug resistance
Drugs
Health services
Linezolid
Multidrug resistance
Multidrug resistant organisms
Multidrug-resistant
Multidrug-resistant; antituberculosis therapy; new drugs; tuberculosis
new drugs
Nitroimidazole
Other systems of medicine
Review
RZ201-999
Sputum
Tuberculosis
Multidrug-resistant
antituberculosis therapy
new drugs
tuberculosis
ISSN:2036-7449, 2036-7430, 2036-7449
Online Access:Get full text
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Summary:Treatment of multidrug-resistant tuberculosis (MDR-TB) cases is challenging because it relies on second-line drugs that are less potent and more toxic than those used in the clinical management of drug-susceptible TB. Moreover, treatment outcomes for MDR-TB are generally poor compared to drug sensitive disease, highlighting the need for of new drugs. For the first time in more than 50 years, two new anti-TB drugs were approved and released. Bedaquiline is a first-in-class diarylquinoline compound that showed durable culture conversion at 24 weeks in phase IIb trials. Delamanid is the first drug of the nitroimidazole class to enter clinical practice. Similarly to bedaquiline results of phase IIb studies showed increased sputum-culture conversion at 2 months and better final treatment outcomes in patients with MDR-TB. Among repurposed drugs linezolid and carbapenems may represent a valuable drug to treat cases of MDR and extensively drugresistant TB. The recommended regimen for MDR-TB is the combination of at least four drugs to which M. tuberculosis is likely to be susceptible for the duration of 20 months. Drugs are chosen with a stepwise selection process through five groups on the basis of efficacy, safety, and cost. Clinical phase III trials on new regimen are ongoing that could prove transformative against MDR-TB, by being shorter (six months), simpler (an alloral regimen) and safer than current standard therapy. It is fundamental that the adoption of the new drugs is done responsibly to avoid inappropriate use. Concentration of inpatient MDR-TB treatment in specialized centers could be considered in countries with low numbers of cases in order to provide appropriate clinical case management and to prevent emergence of drug resistance.
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Conflict of interests: the authors declare no potential conflict of interests.
Contributions: GG designed the content of the review and wrote the manuscript; FP, AM and SC wrote the manuscript; FP and AM critically revised the paper.
ISSN:2036-7449
2036-7430
2036-7449
DOI:10.4081/idr.2016.6569