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Vadankula GR, Nilkanth VV, Rizvi A, Yandrapally S, Agarwal A, Chirra H, Biswas R, Arifuddin M, Nema V, Mallika A, Mande SC, Banerjee S. Confronting Tuberculosis: A Synthetic Quinoline-Isonicotinic Acid Hydrazide Hybrid Compound as a Potent Lead Molecule Against Mycobacterium tuberculosis. ACS Infect Dis 2024; 10:2288-2302. [PMID: 38717380 DOI: 10.1021/acsinfecdis.4c00277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
The current tuberculosis (TB) treatment is challenged by a complex first-line treatment for drug-sensitive (DS) TB. Additionally, the prevalence of multidrug (MDR)- and extensively drug (XDR)-resistant TB necessitates the search for new drug prototypes. We synthesized and screened 30 hybrid compounds containing aminopyridine and 2-chloro-3-formyl quinoline to arrive at a compound with potent antimycobacterial activity, UH-NIP-16. Subsequently, antimycobacterial activity against DS and MDR Mycobacterium tuberculosis (M.tb) strains were performed. It demonstrated an MIC50 value of 1.86 ± 0.21 μM for laboratory pathogenic M.tb strain H37Rv and 3.045 ± 0.813 μM for a clinical M.tb strain CDC1551. UH-NIP-16 also decreased the MIC50 values of streptomycin, isoniazid, ethambutol, and bedaquiline to about 45, 55, 68, and 76%, respectively, when used in combination, potentiating their activities. The molecule was active against a clinical MDR M.tb strain. Cytotoxicity on PBMCs from healthy donors and on human cell lines was found to be negligible. Further, blind docking of UH-NIP-16 using Auto Dock Vina and MGL tools onto diverse M.tb proteins showed high binding affinities with multiple M.tb proteins, the top five targets being metabolically critical proteins CelA1, DevS, MmaA4, lysine acetyltransferase, and immunity factor for tuberculosis necrotizing toxin. These bindings were confirmed by fluorescence spectroscopy using a representative protein, MmaA4. Envisaging that a pathogen will have a lower probability of developing resistance to a hybrid molecule with multiple targets, we propose that UH-NIP-16 can be further developed as a lead molecule with the bacteriostatic potential against M.tb, both alone and in combination with first-line drugs.
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Affiliation(s)
- Govinda Raju Vadankula
- Laboratory of Molecular Pathogenesis, Department of Biochemistry, School of Life Sciences, University of Hyderabad (UoH), Hyderabad 500046, India
| | - Vipul V Nilkanth
- Laboratory of Molecular Pathogenesis, Department of Biochemistry, School of Life Sciences, University of Hyderabad (UoH), Hyderabad 500046, India
- Bioinformatics Centre, Savitribai Phule Pune University, Pune 411007, India
| | - Arshad Rizvi
- Laboratory of Molecular Pathogenesis, Department of Biochemistry, School of Life Sciences, University of Hyderabad (UoH), Hyderabad 500046, India
| | - Sriram Yandrapally
- Laboratory of Molecular Pathogenesis, Department of Biochemistry, School of Life Sciences, University of Hyderabad (UoH), Hyderabad 500046, India
| | - Anushka Agarwal
- Laboratory of Molecular Pathogenesis, Department of Biochemistry, School of Life Sciences, University of Hyderabad (UoH), Hyderabad 500046, India
| | - Hepshibha Chirra
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad 500037, India
| | - Rashmita Biswas
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad 500037, India
| | - Mohammed Arifuddin
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad 500037, India
| | - Vijay Nema
- Molecular Biology Division, ICMR-National Institute for Translational Virology and AIDS Research, Pune 411026, India
| | - Alvala Mallika
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad 500037, India
| | - Shekhar C Mande
- National Centre for Cell Science, Pune 411007, India
- Bioinformatics Centre, Savitribai Phule Pune University, Pune 411007, India
| | - Sharmistha Banerjee
- Laboratory of Molecular Pathogenesis, Department of Biochemistry, School of Life Sciences, University of Hyderabad (UoH), Hyderabad 500046, India
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Pattanaik S, Gota V, Tripathi SK, Kshirsagar NA. Therapeutic drug monitoring in India: A strength, weakness, opportunity and threats analysis. Br J Clin Pharmacol 2023; 89:3247-3261. [PMID: 37259249 DOI: 10.1111/bcp.15808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 04/25/2023] [Accepted: 05/09/2023] [Indexed: 06/02/2023] Open
Abstract
Over the last three to four decades, Therapeutic Drug Monitoring (TDM) has shaped itself as therapeutic drug management, an integral component of precision medicine. The practice of TDM is not extensive in India, despite being one of the fastest-growing economies in the world. It is currently limited to a few academic medical centres and teaching hospitals. Apart from the immunosuppressive drugs, several other therapeutic areas, such as anticancer, antifungal, antibiotic and antitubercular, have demonstrated great potential to improve patient outcomes in Indian settings. Factors such as the higher prevalence of nutritional deficiencies, tropical diseases, widespread use of alternative medicines, unalike pharmacogenomics and sparse population-specific data available on therapeutic ranges of several drugs make the population of this subcontinent unique regarding the relevance of TDM. Despite the impact of TDM in clinical science and its widespread application, TDM has failed to receive the attention it deserves in India. This review intends to bring out a strength, weakness, opportunity and threats (SWOT) analysis for TDM in India so that appropriate steps for fostering the growth of TDM could be envisioned. The need of the hour is the creation of a cooperative group including all the stakeholders, such as TDM professionals, clinicians and the government and devising a National Action Plan to strengthen TDM. Nodal TDM centres should be established, and pilot programmes should be rolled out to identify the thrust areas for TDM in the country, capacity building and creating awareness to integrate TDM into mainstream clinical medicine.
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Affiliation(s)
- Smita Pattanaik
- Clinical Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikram Gota
- Advanced Centre for Treatment Education and Research in Cancer, Tata Memorial Centre, Kharghar Navi Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | | | - Nilima A Kshirsagar
- Clinical Pharmacology, Indian Council of Medical Research, New Delhi, India
- Seth Gordhandas Sunderdas, Medical College and King Edward Memorial Hospital, Mumbai, India
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3
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Li Z, Liu F, Chen H, Han Y, You Y, Xie Y, Zhao Y, Tan J, Guo X, Cheng Y, Wang Y, Li J, Cheng M, Xia S, Niu X, Wei L, Wang W. A five-year review of prevalence and treatment outcomes of pre-extensively drug-resistant plus additional drug-resistant tuberculosis in the Henan Provincial Tuberculosis Clinical Medicine Research Centre. J Glob Antimicrob Resist 2022; 31:328-336. [PMID: 36210030 DOI: 10.1016/j.jgar.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 08/20/2022] [Accepted: 09/23/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES This study investigated the prevalence and significant clinical outcomes of pre-extensively drug-resistant plus additional drug-resistant tuberculosis (pre-XDR-plus) in Henan Provincial Chest Hospital between 2017 and 2021. METHODS We analysed and summarized the drug sensitivity test (DST) results of clinical Mycobacterium tuberculosis (MTB) strains in TB patients seeking care in the Tuberculosis Clinical Medical Research Centre of Henan Province between 2017 and 2021. Medical records of pre-extensively drug-resistant plus additional drug-resistant TB patients were statistically analysed, including demographic characteristics, regimens, and outcomes. RESULTS Of the 3689 Mycobacterium tuberculosis strains, 639 (17.32%), 353 (9.56%), and 109 (2.95%), multidrug-resistant tuberculosis (MDR-TB), pre-extensively drug-resistant tuberculosis (pre-XDR), and pre-XDR-plus, respectively. The proportion of MDR decreased from 19.1% in 2017 to 17.5% in 2021 (χ2 = 0.686, P = 0.407), the proportion of pre-XDR from 11.4% in 2017 to 9.0% in 2021 (χ2 = 2.39, P = 0.122), and pre-XDR-plus from 4.7% in 2017 to 1.8% in 2020, with the declining trend was significant (χ2 = 9.348, P = 0.002). The most commonly used anti-TB drugs were pyrazinamide (PZA, 37/46, 80.43%) and cycloserine (CS, 32/46, 69.57%), followed by linezolid (LZD, 25/46, 54.35%), protionamide (TH, 25/46, 54.35%), and para-aminosalicylic acid (PAS, 23/46, 50.00%). Patients receiving the LZD regimen were 5 times more likely to have a favourable outcome than those not receiving LZD (OR = 6.421, 95% CI 2.101-19.625, P = 0.001). Patients receiving a regimen containing CS were 4 times more likely to have a favourable outcome compared to those not taking CS (OR = 5.444, 95% CI 1.650-17.926, P = 0.005). CONCLUSIONS Our data suggest that the population of pre-XDR-plus had significantly decreased over the past five years in the Henan Provincial Chest Hospital. The COVID-19 and flood disaster affect TB patients' selection of medical services. In addition, the pre-XDR-plus patients whose regimens contain LZD or CS were more likely to have favourable outcomes.
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Affiliation(s)
- Zheng Li
- Department of Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou, China.
| | - Fuyong Liu
- School of Basic Medical Sciences, Sanquan College of Xinxiang Medical University, Xinxiang, China
| | - Huihui Chen
- Department of Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Yungang Han
- Department of Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Yonghe You
- School of Basic Medical Sciences, Sanquan College of Xinxiang Medical University, Xinxiang, China
| | - Yongsheng Xie
- School of Basic Medical Sciences, Sanquan College of Xinxiang Medical University, Xinxiang, China
| | - Yue Zhao
- Department of Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Jiao Tan
- Department of Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Xu Guo
- Department of Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Yuntao Cheng
- Department of Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Yali Wang
- Department of Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Jing Li
- Department of Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Meijin Cheng
- Department of Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Shuang Xia
- Department of Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Xiaodong Niu
- Department of Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Lukuan Wei
- Department of Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Wei Wang
- Department of Medical Laboratory, Henan Provincial Chest Hospital, Zhengzhou, China.
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Verma N, Arora V, Awasthi R, Chan Y, Jha NK, Thapa K, Jawaid T, Kamal M, Gupta G, Liu G, Paudel KR, Hansbro PM, George Oliver BG, Singh SK, Chellappan DK, Dureja H, Dua K. Recent developments, challenges and future prospects in advanced drug delivery systems in the management of tuberculosis. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Rapid diagnosis of XDR and pre-XDR TB: a systematic review of available tools. Arch Bronconeumol 2022; 58:809-820. [DOI: 10.1016/j.arbres.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 11/23/2022]
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Pooranagangadevi N, Padmapriyadarsini C. Treatment of Tuberculosis and the Drug Interactions Associated With HIV-TB Co-Infection Treatment. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.834013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Tuberculosis (TB) is a communicable disease that is a major source of illness, one of the ten causes of mortality worldwide, and the largest cause of death from a single infectious agent Mycobacterium tuberculosis. HIV infection and TB are a fatal combination, with each speeding up the progression of the other. Barriers to integrated treatment as well as safety concerns on the co-management of HIV- TB co-infection do exist. Many HIV TB co-infected people require concomitant anti-retroviral therapy (ART) and anti-TB medication, which increases survival but also introduces certain management issues, such as drug interactions, combined drug toxicities, and TB immune reconstitution inflammatory syndrome which has been reviewed here. In spite of considerable pharmacokinetic interactions between antiretrovirals and antitubercular drugs, when the pharmacological characteristics of drugs are known and appropriate combination regimens, dosing, and timing of initiation are used, adequate clinical response of both infections can be achieved with an acceptable safety profile. To avoid undesirable drug interactions and side effects in patients, anti TB treatment and ART must be closely monitored. To reduce TB-related mortality among HIV-TB co-infected patients, ART and ATT (Anti Tuberculosis Treatment) outcomes must improve. Clinical practise should prioritise strategies to promote adherence, such as reducing treatment duration, monitoring and treating adverse events, and improving treatment success rates, to reduce the mortality risk of HIV-TB co-infection.
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Mulder C, Rupert S, Setiawan E, Mambetova E, Edo P, Sugiharto J, Useni S, Malhotra S, Cook-Scalise S, Pambudi I, Kadyrov A, Lawanson A, van den Hof S, Gebhard A, Juneja S, Sohn H. Budgetary impact of using BPaL for treating extensively drug-resistant tuberculosis. BMJ Glob Health 2022; 7:bmjgh-2021-007182. [PMID: 34992077 PMCID: PMC8739433 DOI: 10.1136/bmjgh-2021-007182] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/12/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Bedaquiline, pretomanid and linezolid (BPaL) is a new all oral, 6-month regimen comprised of bedaquiline, the new drug pretomanid and linezolid, endorsed by the WHO for use under operational research conditions in patients with extensively drug-resistant tuberculosis (XDR-TB). We quantified per-patient treatment costs and the 5-year budgetary impact of introducing BPaL in Indonesia, Kyrgyzstan and Nigeria. Methods Per-patient treatment cost of BPaL regimen was compared head-to-head with the conventional XDR-TB treatment regimen for respective countries based on cost estimates primarily assessed using microcosting method and expected frequency of each TB service. The 5-year budget impact of gradual introduction of BPaL against the status quo was assessed using a Markov model that represented patient’s treatment management and outcome pathways. Results The cost per patient completing treatment with BPaL was US$7142 in Indonesia, US$4782 in Kyrgyzstan and US$7152 in Nigeria – 57%, 78% and 68% lower than the conventional regimens in the respective countries. A gradual adoption of the BPaL regimen over 5 years would result in an 5-year average national TB service budget reduction of 17% (US$128 780) in XDR-TB treatment-related expenditure in Indonesia, 15% (US$700 247) in Kyrgyzstan and 32% (US$1 543 047) in Nigeria. Conclusion Our study demonstrates that the BPaL regimen can be highly cost-saving compared with the conventional regimens to treat patients with XDR-TB in high drug-resistant TB burden settings. This supports the rapid adoption of the BPaL regimen to address the significant programmatic and clinical challenges in managing patients with XDR-TB in high DR-TB burden countries.
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Affiliation(s)
- Christiaan Mulder
- Technical Division, KNCV Tuberculosis Foundation, The Hague, The Netherlands .,Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Stephan Rupert
- Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | | | | | | | | | - Sani Useni
- KNCV Tuberculosis Foundation, Abuja, Nigeria
| | - Shelly Malhotra
- Market Access, Global Alliance for TB Drug Development, New York, New York, USA.,Global Access, International Aids Vaccine Initiative, New York, New York, USA
| | - Sarah Cook-Scalise
- Market Access, Global Alliance for TB Drug Development, New York, New York, USA.,Bureau For Global Health, USAID, Washington, DC, USA
| | - Imran Pambudi
- National TB Program, Ministry of Health of the Republic of Indonesia, Jakarta, Indonesia
| | - Abdullaat Kadyrov
- National Center of Phtiziatry, National TB Program, Bishkek, Kyrgyzstan
| | - Adebola Lawanson
- National Tuberculosis and Leprosy Control Programme, Federal Ministry of Health, Abuja, Nigeria
| | - Susan van den Hof
- Technical Division, KNCV Tuberculosis Foundation, The Hague, The Netherlands.,Centre for Infectious Disease Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Agnes Gebhard
- Technical Division, KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Sandeep Juneja
- Market Access, Global Alliance for TB Drug Development, New York, New York, USA
| | - Hojoon Sohn
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Mukoro G, Dibal W. Analytical evaluation of Mycobacterium tuberculosis detection in a local comprehensive tuberculosis center following the introduction of genexpert: A cartridge-based nucleic acid amplification test. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_114_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
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9
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Ushtanit A, Mikhailova Y, Lyubimova A, Makarova M, Safonova S, Filippov A, Borisov S, Zimenkov D. Genetic Profile of Linezolid-Resistant M. tuberculosis Clinical Strains from Moscow. Antibiotics (Basel) 2021; 10:antibiotics10101243. [PMID: 34680823 PMCID: PMC8532644 DOI: 10.3390/antibiotics10101243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/06/2021] [Accepted: 10/11/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Linezolid, bedaquiline, and newer fluoroquinolones are currently placed as priority Group A drugs for the treatment of drug-resistant tuberculosis. The number of reported linezolid-resistant clinical strains is still low, and the correlation of molecular determinants with phenotype is not perfect. Methods: We determined the linezolid MICs for clinical isolates from the Moscow region and identified mutations in rplC and rrl genes. Results: All 16 linezolid-resistant isolates had previously reported mutations in the rplC or rrl loci, and 13 of them bore a RplC C154R substitution. Detection of this substitution in a heteroresistant state was not successful, probably, due to the more stable DNA secondary structure of the mutated fragment, which precludes its amplification in mixes with the wild-type DNA. Strains with an rplC mutation had higher linezolid MIC compared to isolates with rrl mutations. Conclusions: Linezolid resistance mostly emerged during treatment with the latest regimen. Three primary cases with linezolid resistance question the possible transmission of totally drug-resistant tuberculosis in the Moscow region, which demands further investigation.
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Affiliation(s)
- Anastasia Ushtanit
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia; (A.U.); (A.L.)
| | - Yulia Mikhailova
- The Moscow Research and Clinical Center for Tuberculosis Control, Moscow Government Health Department, 107014 Moscow, Russia; (Y.M.); (M.M.); (S.S.); (A.F.); (S.B.)
| | - Alexandra Lyubimova
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia; (A.U.); (A.L.)
| | - Marina Makarova
- The Moscow Research and Clinical Center for Tuberculosis Control, Moscow Government Health Department, 107014 Moscow, Russia; (Y.M.); (M.M.); (S.S.); (A.F.); (S.B.)
| | - Svetlana Safonova
- The Moscow Research and Clinical Center for Tuberculosis Control, Moscow Government Health Department, 107014 Moscow, Russia; (Y.M.); (M.M.); (S.S.); (A.F.); (S.B.)
| | - Alexey Filippov
- The Moscow Research and Clinical Center for Tuberculosis Control, Moscow Government Health Department, 107014 Moscow, Russia; (Y.M.); (M.M.); (S.S.); (A.F.); (S.B.)
| | - Sergey Borisov
- The Moscow Research and Clinical Center for Tuberculosis Control, Moscow Government Health Department, 107014 Moscow, Russia; (Y.M.); (M.M.); (S.S.); (A.F.); (S.B.)
| | - Danila Zimenkov
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia; (A.U.); (A.L.)
- Correspondence:
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Mase S, Chorba T, Parks S, Belanger A, Dworkin F, Seaworth B, Warkentin J, Barry P, Shah N. Bedaquiline for the Treatment of Multidrug-resistant Tuberculosis in the United States. Clin Infect Dis 2021; 71:1010-1016. [PMID: 31556947 DOI: 10.1093/cid/ciz914] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 09/17/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In 2012, the Food and Drug Administration approved use of bedaquiline fumarate as part of combination therapy for multidrug-resistant tuberculosis (MDR TB). We describe treatment outcomes, safety, and tolerability of bedaquiline in our case series. METHODS Data on patients started on bedaquiline for MDR TB between September 2012 and August 2016 were collected retrospectively through 4 TB programs using a standardized abstraction tool. Data were analyzed using univariate methods. Adverse events were graded using the Common Terminology Criteria for Adverse Events. RESULTS Of 14 patients, 7 (50%) had MDR, 4 (29%) had pre-extensively drug-resistant (XDR), and 3 (21%) had XDR TB. All had pulmonary TB, 5 (36%) had pulmonary and extrapulmonary TB, and 9/13 (69%) were smear positive. One patient (7%) had HIV coinfection, 5 (36%) had diabetes mellitus, and 5/14 (36%) had previous treatment TB. All patients were non-US-born and 5/14 (36%) had private insurance. All patients achieved sputum culture conversion within a mean of 71 days (26-116); 5 after starting bedaquiline. Twelve (86%) completed treatment and 1 (7%) moved out of the country. One patient (7%) had QTc prolongation >500 milliseconds and died 20 months after discontinuing bedaquiline of a cause not attributable to the drug. Common adverse events were peripheral neuropathy 7/14 (50%), not customarily associated with bedaquiline use, and QTc prolongation 6/14 (43%). CONCLUSIONS Of 14 patients, 1 (7%) had an adverse event necessitating bedaquiline discontinuation. Safety, culture conversion, and treatment completion in this series (7%) support use of bedaquiline for the treatment of MDR/XDR TB.
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Affiliation(s)
- Sundari Mase
- World Health Organization, India Country Office, Delhi, India
| | - Terence Chorba
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Samuel Parks
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ann Belanger
- Tuberculosis Control Branch, California Department of Public Health, Richmond, California, USA
| | - Felicia Dworkin
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, New York, USA
| | | | - Jon Warkentin
- Tuberculosis Elimination Program, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Pennan Barry
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Neha Shah
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Tuberculosis Control Branch, California Department of Public Health, Richmond, California, USA
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de Kraker MEA, Lipsitch M. Burden of Antimicrobial Resistance: Compared to What? Epidemiol Rev 2021; 43:53-64. [PMID: 33710259 PMCID: PMC8763122 DOI: 10.1093/epirev/mxab001] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 03/03/2021] [Accepted: 03/09/2021] [Indexed: 02/07/2023] Open
Abstract
The increased focus on the public health burden of antimicrobial resistance (AMR) raises conceptual challenges, such as determining how much harm multidrug-resistant organisms do compared to what, or how to establish the burden. Here, we present a counterfactual framework and provide guidance to harmonize methodologies and optimize study quality. In AMR-burden studies, 2 counterfactual approaches have been applied: the harm of drug-resistant infections relative to the harm of the same drug-susceptible infections (the susceptible-infection counterfactual); and the total harm of drug-resistant infections relative to a situation where such infections were prevented (the no-infection counterfactual). We propose to use an intervention-based causal approach to determine the most appropriate counterfactual. We show that intervention scenarios, species of interest, and types of infections influence the choice of counterfactual. We recommend using purpose-designed cohort studies to apply this counterfactual framework, whereby the selection of cohorts (patients with drug-resistant, drug-susceptible infections, and those with no infection) should be based on matching on time to infection through exposure density sampling to avoid biased estimates. Application of survival methods is preferred, considering competing events. We conclude by advocating estimation of the burden of AMR by using the no-infection and susceptible-infection counterfactuals. The resulting numbers will provide policy-relevant information about the upper and lower bound of future interventions designed to control AMR. The counterfactuals should be applied in cohort studies, whereby selection of the unexposed cohorts should be based on exposure density sampling, applying methods avoiding time-dependent bias and confounding.
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Affiliation(s)
- Marlieke E A de Kraker
- Correspondence to Dr. Marlieke E.A. de Kraker, Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle Perret Gentil 4, CH-1205 Geneva, Switzerland (e-mail: )
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12
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Ghosh S, Breitscheidel L, Lazarevic N, Martin A, Hafkin J, Hittel N. Compassionate use of delamanid in adults and children for drug-resistant tuberculosis: 5-year update. Eur Respir J 2020; 57:13993003.02483-2020. [PMID: 33243846 DOI: 10.1183/13993003.02483-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/13/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although delamanid has been approved for the treatment of multidrug-resistant TB (MDR-TB) in numerous regions, in areas where it is not yet registered it can be accessed as part of salvage therapy (in particular for those patients with limited treatment options) via the Otsuka compassionate use programme. Here we present the analysis of interim treatment outcomes by 24 weeks of more than 200 MDR-TB patients globally who received delamanid under this programme. METHODS We evaluated treatment efficacy with respect to culture negativity at 24 weeks, as well as the safety profile of delamanid, in an MDR-TB patient cohort treated under compassionate use between 2014 and 2019. RESULTS Among patients who received delamanid as part of a multidrug regimen, 123 (61%) out of 202 had extensively drug-resistant TB (XDR-TB), 66 (33%) out of 202 had HIV co-infection and 34 (17%) out of 202 were children aged between 6 and 17 years. Of those patients who were culture positive at delamanid treatment initiation and who completed 24 weeks of delamanid treatment in combination with other anti-tuberculosis (TB) drugs, culture negativity was achieved in 116 (79%) out of 147 cases. The corresponding rates of culture negativity for patients with XDR-TB and HIV co-infection, as well as the paediatric subgroup were 69 (77%) out of 90, 44 (92%) out of 48 and 20 (80%) out of 25, respectively. QT interval prolongation was the most frequently observed serious adverse event and was reported in 8% of patients receiving delamanid. Overall, treatment safety outcomes did not reveal any new or unidentified risks. CONCLUSIONS The use of delamanid combined with other active drugs has the potential to achieve high rates of culture negativity in difficult-to-treat drug-resistant TB cases, with a favourable safety profile.
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Affiliation(s)
| | | | | | | | - Jeffrey Hafkin
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
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13
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Khawbung JL, Nath D, Chakraborty S. Drug resistant Tuberculosis: A review. Comp Immunol Microbiol Infect Dis 2020; 74:101574. [PMID: 33249329 DOI: 10.1016/j.cimid.2020.101574] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/05/2020] [Indexed: 12/14/2022]
Abstract
Tuberculosis (TB) was announced as a global emergency in 1993. There was an alarming counter attack of TB worldwide. However, when it was known that TB can be cured completely, the general public became ignorant towards the infection. The pathogenic organism Mycobacterium tuberculosis continuously evolved to resist the antagonist drugs. This has led to the outbreak of resistant strain that gave rise to "Multi Drug Resistant-Tuberculosis" and "Extensively Drug Resistant Tuberculosis" that can still be cured with a lower success rate. While the mechanism of resistance proceeds further, it ultimately causes unmanageable totally drug resistant TB (TDR-TB). Studying the molecular mechanisms underlying the resistance to drugs would help us grasp the genetics and pathophysiology of the disease. In this review, we present the molecular mechanisms behind Mycobacterium tolerance to drugs and their approach towards the development of multi-drug resistant, extremely drug resistant and totally drug resistant TB.
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Affiliation(s)
| | - Durbba Nath
- Department of Biotechnology, Assam University, Silchar, 788011, Assam, India
| | - Supriyo Chakraborty
- Department of Biotechnology, Assam University, Silchar, 788011, Assam, India.
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14
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Outcomes and adverse events of pre- and extensively drug-resistant tuberculosis patients in Kinshasa, Democratique Republic of the Congo: A retrospective cohort study. PLoS One 2020; 15:e0236264. [PMID: 32750060 PMCID: PMC7402497 DOI: 10.1371/journal.pone.0236264] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 07/01/2020] [Indexed: 11/30/2022] Open
Abstract
Background Extensively drug-resistant tuberculosis (XDR TB) is a very serious form of tuberculosis that is burdened with a heavy mortality toll, especially before the advent of new TB drugs. The Democratic Republic of the Congo (DRC) is among the countries most affected by this new epidemic. Methods A retrospective analysis was performed of the records of all patients with pre- and extensively drug-resistant tuberculosis hospitalized from January 1, 2015 to December 31, 2017 and monitored for at least 6 months to one year after the end of their treatment in Kinshasa; an individualized therapeutic regimen with bedaquiline for 20 months was built for each patient. The adverse effects were systematically monitored. Results Of the 40 laboratory-confirmed patients, 32 (80%) patients started treatment, including 29 preXRB and 3 XDR TB patients. In the eligible group, 3 patients (9.4%) had HIV-TB coinfections. The therapeutic success rate was 53.2%, and the mortality rate was 46.8% (15/32); there were no relapses, failures or losses to follow-up. All coinfected HIV–TB patients died during treatment. The cumulative patient survival rate was 62.5% at 3 months, 53.1% at 6 months and 53.1% at 20 months. The most common adverse events were vomiting, Skin rash, anemia and peripheral neuropathy. Conclusion The new anti-tuberculosis drugs are a real hope for the management of Drug Resistant tuberculosis patient and other new therapeutic combinations may improve favorable outcomes.
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15
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Campbell JR, Falzon D, Mirzayev F, Jaramillo E, Migliori GB, Mitnick CD, Ndjeka N, Menzies D. Improving Quality of Patient Data for Treatment of Multidrug- or Rifampin-Resistant Tuberculosis. Emerg Infect Dis 2020; 26. [PMID: 31922953 PMCID: PMC7045826 DOI: 10.3201/eid2603.190997] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
International policy for treatment of multidrug- and rifampin-resistant tuberculosis (MDR/RR TB) relies largely on individual patient data (IPD) from observational studies of patients treated under routine conditions. We prepared guidance on which data to collect and what measures could improve consistency and utility for future evidence-based recommendations. We highlight critical stages in data collection at which improvements to uniformity, accuracy, and completeness could add value to IPD quality. Through a repetitive development process, we suggest essential patient- and treatment-related characteristics that should be collected by prospective contributors of observational IPD in MDR/RR TB.
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16
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Sharma D, Sharma S, Sharma J. Potential strategies for the management of drug-resistant tuberculosis. J Glob Antimicrob Resist 2020; 22:210-214. [PMID: 32169684 DOI: 10.1016/j.jgar.2020.02.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/18/2019] [Accepted: 02/26/2020] [Indexed: 12/30/2022] Open
Abstract
In the current scenario, the emergence of drug resistance in Mycobacterium tuberculosis is the consequence of the failure of conventional diagnostic and treatment approaches. To combat this global emergence of drug resistance, alternative approaches such as pathogen-centric (use of repurposed drugs, novel analogues of existing anti-TB drugs and novel compounds with a different mechanism of action), host-centric (immunomodulatory agents, therapeutic vaccines, immune and cellular therapies) and nano-based drug/vaccine delivery should be used singly or in combination. Diverse types of nano-carriers have assessed as auspicious diagnostic and drug delivery systems. In this focused review, we have suggested a long-term solution for combating antimicrobial resistance and also an attractive means to increase patient compliance and reduce treatment duration.
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Affiliation(s)
- Divakar Sharma
- Department of Biochemistry, National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Tajganj, Agra 282004, India.
| | - Sandeep Sharma
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Medical Laboratory Sciences, Division of Research and Development, Lovely Professional University, Phagwara, Punjab 144411, India
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17
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Role of linezolid combination therapy for serious infections: review of the current evidence. Eur J Clin Microbiol Infect Dis 2020; 39:1043-1052. [PMID: 31898798 DOI: 10.1007/s10096-019-03801-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/17/2019] [Indexed: 01/24/2023]
Abstract
As long-standing clinical problems, a series of complicated infections are more difficult to treat due to the development of antibiotic resistance, especially caused by methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecium (VRE), and multidrug-resistant Mycobacterium tuberculosis (M. tuberculosis). Moreover, the treatment options available to against these infections are also becoming increasingly limited. Linezolid is the first synthetic oxazolidinone antibiotic with a unique mechanism of action, and its efficacy against Gram-positive bacteria has been clearly demonstrated. However, the limitations of linezolid alone for the treatment of these complicated infections have been reported in the recent years. Combination therapy may be a good approach to enhance efficacy and prevent the development of resistance. In this review, the results of multiple linezolid combination therapies from in vitro, animal studies, and clinical cases for the treatment of MRSA, VRE, and multidrug-resistant M. tuberculosis strains will be discussed, and thus provide more relevant information for clinician in clinical practice.
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18
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Guo P, Qiao W, Sun Y, Liu F, Wang C. Telemedicine Technologies and Tuberculosis Management: A Randomized Controlled Trial. Telemed J E Health 2019; 26:1150-1156. [PMID: 31794684 DOI: 10.1089/tmj.2019.0190] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Since 1990s, directly observed therapy (DOT) has been the standard-of-care for tuberculosis (TB), although it is cumbersome for patients as well as service providers. For raising implementation, an alternative delivery method with good potential is telehealth. The current study assessed the clinical and cost benefit of video directly observed therapy (VDOT), compared with DOT service. Methods: This prospective randomized controlled trial randomized adults with bacteriologically confirmed pulmonary TB to the intervention (VDOT) or control (DOT) group. The observation data for DOT and VDOT were updated by observers until the end of treatment or until the study concluded. The primary outcome was the TB treatment result defined by the World Health Organization (WHO) as used in some other studies conducted in North India and England as follows: good (cured and treatment completed), poor (death and failure), relocation, and lost to follow-up and others (refused, adverse reaction, not a TB case). Other secondary measures were treatment adherence, patient satisfaction, time and cost spent on DOT or VDOT. Results: On analyzing the results from 405 participants from each study arm, we found very high rates of treatment completion (96.1% with VDOT vs. 94.6% with DOT). The two observed treatment methods had no statistical differences, and all could accomplish their tasks well. Average time per dose observed was 16.5 min (standard deviation [SD] 12.1) for VDOT, while 44.1 min (SD 3.7) for DOT (including travel time), p < 0.01. And the cost incurred on VDOT was ¥34.3 (SD 3.8) manmo, which was statistically lower compared with ¥71.6 (SD 49.7) manmo in the DOT group, p < 0.01. Most of the patients in both groups believed that observed treatment (VDOT/DOT) helped them not to miss doses (185 [93.0%] vs. 171 [86.7%], p = 0.057). Patients in the VDOT group had a better experience compared with those in DOT group. They thought the way was convenient and comfortable (191 [96.0%] vs. 111 [56.6%], p < 0.001), would choose the original way if necessary (191 [96.0%] vs. 113 [57.7%], p < 0.001), and would recommend the method to other patients (191 [96.0%] vs. 113 [57.7%], p < 0.001). Conclusion: The study showed that VDOT enabled meaningful direct observation for TB patients through mobile devices, which was highly acceptable to patients and health care providers. It also saved time and is a cost-effective method, enabling the use of the saved money to other much-needed areas for TB.
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Affiliation(s)
- Peng Guo
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Chest Hospital Affiliated to Shandong University, Jinan, China
| | - Wei Qiao
- Department of Respiration, Weihai Chest Hospital, Weihai, China
| | - Ying Sun
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Chest Hospital Affiliated to Shandong University, Jinan, China
| | - Fenglin Liu
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Chest Hospital Affiliated to Shandong University, Jinan, China
| | - Chunting Wang
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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19
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Tiberi S, Zumla A, Migliori GB. Multidrug and Extensively Drug-resistant Tuberculosis. Infect Dis Clin North Am 2019; 33:1063-1085. [DOI: 10.1016/j.idc.2019.09.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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20
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Deshpande D, Pasipanodya JG, Srivastava S, Bendet P, Koeuth T, Bhavnani SM, Ambrose PG, Smythe W, McIlleron H, Thwaites G, Gumusboga M, Van Deun A, Gumbo T. Gatifloxacin Pharmacokinetics/Pharmacodynamics-based Optimal Dosing for Pulmonary and Meningeal Multidrug-resistant Tuberculosis. Clin Infect Dis 2019; 67:S274-S283. [PMID: 30496459 DOI: 10.1093/cid/ciy618] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background Gatifloxacin is used for the treatment of multidrug-resistant tuberculosis (MDR-TB). The optimal dose is unknown. Methods We performed a 28-day gatifloxacin hollow-fiber system model of tuberculosis (HFS-TB) study in order to identify the target exposures associated with optimal kill rates and resistance suppression. Monte Carlo experiments (MCE) were used to identify the dose that would achieve the target exposure in 10000 adult patients with meningeal or pulmonary MDR-TB. The optimal doses identified were validated using probit analyses of clinical data from 2 prospective clinical trials of patients with pulmonary and meningeal tuberculosis. Classification and regression-tree (CART) analyses were used to identify the gatifloxacin minimum inhibitory concentration (MIC) below which patients failed or relapsed on combination therapy. Results The target exposure associated with optimal microbial kill rates and resistance suppression in the HFS-TB was a 0-24 hour area under the concentration-time curve-to-MIC of 184. MCE identified an optimal gatifloxacin dose of 800 mg/day for pulmonary and 1200 mg/day for meningeal MDR-TB, and a clinical susceptibility breakpoint of MIC ≤ 0.5 mg/L. In clinical trials, CART identified that 79% patients failed therapy if MIC was >2 mg/L, but 98% were cured if MIC was ≤0.5 mg/L. Probit analysis of clinical data demonstrated a >90% probability of a cure in patients if treated with 800 mg/day for pulmonary tuberculosis and 1200 mg/day for meningeal tuberculosis. Doses ≤400 mg/day were suboptimal. Conclusions Gatifloxacin doses of 800 mg/day and 1200 mg/day are recommended for pulmonary and meningeal MDR-TB treatment, respectively. Gatifloxacin has a susceptible dose-dependent zone at MICs 0.5-2 mg/L.
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Affiliation(s)
- Devyani Deshpande
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | - Jotam G Pasipanodya
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | - Shashikant Srivastava
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | - Paula Bendet
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | - Thearith Koeuth
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
| | | | - Paul G Ambrose
- Institute for Clinical Pharmacodynamics, Schenectady, New York
| | - Wynand Smythe
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Observatory, South Africa
| | - Helen McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Observatory, South Africa
| | - Guy Thwaites
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Churchill Hospital, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Armand Van Deun
- Institute of Tropical Medicine, Antwerp, Belgium.,International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Tawanda Gumbo
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
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21
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Hu JP, Wu ZX, Xie T, Liu XY, Yan X, Sun X, Liu W, Liang L, He G, Gan Y, Gou XJ, Shi Z, Zou Q, Wan H, Shi HB, Chang S. Applications of Molecular Simulation in the Discovery of Antituberculosis Drugs: A Review. Protein Pept Lett 2019; 26:648-663. [PMID: 31218945 DOI: 10.2174/0929866526666190620145919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 04/10/2019] [Accepted: 05/03/2019] [Indexed: 02/05/2023]
Abstract
After decades of efforts, tuberculosis has been well controlled in most places. The existing drugs are no longer sufficient for the treatment of drug-resistant Mycobacterium tuberculosis due to significant toxicity and selective pressure, especially for XDR-TB. In order to accelerate the development of high-efficiency, low-toxic antituberculosis drugs, it is particularly important to use Computer Aided Drug Design (CADD) for rational drug design. Here, we systematically reviewed the specific role of molecular simulation in the discovery of new antituberculosis drugs. The purpose of this review is to overview current applications of molecular simulation methods in the discovery of antituberculosis drugs. Furthermore, the unique advantages of molecular simulation was discussed in revealing the mechanism of drug resistance. The comprehensive use of different molecular simulation methods will help reveal the mechanism of drug resistance and improve the efficiency of rational drug design. With the help of molecular simulation methods such as QM/MM method, the mechanisms of biochemical reactions catalyzed by enzymes at atomic level in Mycobacterium tuberculosis has been deeply analyzed. QSAR and virtual screening both accelerate the development of highefficiency, low-toxic potential antituberculosis drugs. Improving the accuracy of existing algorithms and developing more efficient new methods for CADD will always be a hot topic in the future. It is of great value to utilize molecular dynamics simulation to investigate complex systems that cannot be studied in experiments, especially for drug resistance of Mycobacterium tuberculosis.
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Affiliation(s)
- Jian-Ping Hu
- College of Pharmacy and Biological Engineering, Sichuan Industrial Institute of Antibiotics, Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Chengdu University, Chengdu, China
| | - Zhi-Xiang Wu
- College of Pharmacy and Biological Engineering, Sichuan Industrial Institute of Antibiotics, Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Chengdu University, Chengdu, China
| | - Tao Xie
- College of Pharmacy and Biological Engineering, Sichuan Industrial Institute of Antibiotics, Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Chengdu University, Chengdu, China
| | - Xin-Yu Liu
- Laboratory of Tumor Targeted and Immune Therapy, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, China
| | - Xiao Yan
- College of Pharmacy and Biological Engineering, Sichuan Industrial Institute of Antibiotics, Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Chengdu University, Chengdu, China
| | - Xin Sun
- College of Pharmacy and Biological Engineering, Sichuan Industrial Institute of Antibiotics, Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Chengdu University, Chengdu, China
| | - Wei Liu
- College of Pharmacy and Biological Engineering, Sichuan Industrial Institute of Antibiotics, Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Chengdu University, Chengdu, China
| | - Li Liang
- College of Pharmacy and Biological Engineering, Sichuan Industrial Institute of Antibiotics, Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Chengdu University, Chengdu, China
| | - Gang He
- College of Pharmacy and Biological Engineering, Sichuan Industrial Institute of Antibiotics, Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Chengdu University, Chengdu, China
| | - Ya Gan
- College of Pharmacy and Biological Engineering, Sichuan Industrial Institute of Antibiotics, Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Chengdu University, Chengdu, China
| | - Xiao-Jun Gou
- College of Pharmacy and Biological Engineering, Sichuan Industrial Institute of Antibiotics, Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Chengdu University, Chengdu, China
| | - Zheng Shi
- College of Pharmacy and Biological Engineering, Sichuan Industrial Institute of Antibiotics, Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Chengdu University, Chengdu, China
| | - Qiang Zou
- College of Pharmacy and Biological Engineering, Sichuan Industrial Institute of Antibiotics, Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Chengdu University, Chengdu, China
| | - Hua Wan
- College of Mathematics and Informatics, South China Agricultural University, Guangzhou, China
| | - Hu-Bing Shi
- Laboratory of Tumor Targeted and Immune Therapy, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, China
| | - Shan Chang
- Institute of Bioinformatics and Medical Engineering, School of Electrical and Information Engineering, Jiangsu University of Technology, Changzhou, China
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22
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Millard J, Pertinez H, Bonnett L, Hodel EM, Dartois V, Johnson JL, Caws M, Tiberi S, Bolhuis M, Alffenaar JWC, Davies G, Sloan DJ. Linezolid pharmacokinetics in MDR-TB: a systematic review, meta-analysis and Monte Carlo simulation. J Antimicrob Chemother 2019; 73:1755-1762. [PMID: 29584861 PMCID: PMC6005026 DOI: 10.1093/jac/dky096] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/26/2018] [Indexed: 01/16/2023] Open
Abstract
Objectives The oxazolidinone linezolid is an effective component of drug-resistant TB treatment, but its use is limited by toxicity and the optimum dose is uncertain. Current strategies are not informed by clinical pharmacokinetic (PK)/pharmacodynamic (PD) data; we aimed to address this gap. Methods We defined linezolid PK/PD targets for efficacy (fAUC0–24:MIC >119 mg/L/h) and safety (fCmin <1.38 mg/L). We extracted individual-level linezolid PK data from existing studies on TB patients and performed meta-analysis, producing summary estimates of fAUC0–24 and fCmin for published doses. Combining these with a published MIC distribution, we performed Monte Carlo simulations of target attainment. Results The efficacy target was attained in all simulated individuals at 300 mg q12h and 600 mg q12h, but only 20.7% missed the safety target at 300 mg q12h versus 98.5% at 600 mg q12h. Although suggesting 300 mg q12h should be used preferentially, these data were reliant on a single centre. Efficacy and safety targets were missed by 41.0% and 24.2%, respectively, at 300 mg q24h and by 44.6% and 27.5%, respectively, at 600 mg q24h. However, the confounding effect of between-study heterogeneity on target attainment for q24h regimens was considerable. Conclusions Linezolid dosing at 300 mg q12h may retain the efficacy of the 600 mg q12h licensed dosing with improved safety. Data to evaluate commonly used 300 mg q24h and 600 mg q24h doses are limited. Comprehensive, prospectively obtained PK/PD data for linezolid doses in drug-resistant TB treatment are required.
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Affiliation(s)
- James Millard
- Wellcome Trust Liverpool Glasgow Centre for Global Health Research, Liverpool, UK.,Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,Africa Health Research Institute, Durban, South Africa
| | - Henry Pertinez
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Laura Bonnett
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Eva Maria Hodel
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK.,Liverpool School of Tropical Medicine, Liverpool, UK
| | - Véronique Dartois
- Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - John L Johnson
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Maxine Caws
- Liverpool School of Tropical Medicine, Liverpool, UK.,Birat-Nepal Medical Trust, Lazimpat, Kathmandu, Nepal
| | - Simon Tiberi
- Department of Infection, Barts Health National Health Service Trust, London, UK
| | - Mathieu Bolhuis
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, The Netherlands
| | - Jan-Willem C Alffenaar
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, The Netherlands
| | - Geraint Davies
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Derek J Sloan
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,Liverpool School of Tropical Medicine, Liverpool, UK.,School of Medicine, University of St Andrews, St Andrews, UK
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Osman M, Harausz EP, Garcia-Prats AJ, Schaaf HS, Moore BK, Hicks RM, Achar J, Amanullah F, Barry P, Becerra M, Chiotan DI, Drobac PC, Flood J, Furin J, Gegia M, Isaakidis P, Mariandyshev A, Ozere I, Shah NS, Skrahina A, Yablokova E, Seddon JA, Hesseling AC. Treatment Outcomes in Global Systematic Review and Patient Meta-Analysis of Children with Extensively Drug-Resistant Tuberculosis. Emerg Infect Dis 2019; 25:441-450. [PMID: 30789141 PMCID: PMC6390755 DOI: 10.3201/eid2503.180852] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Extensively drug-resistant tuberculosis (XDR TB) has extremely poor treatment outcomes in adults. Limited data are available for children. We report on clinical manifestations, treatment, and outcomes for 37 children (<15 years of age) with bacteriologically confirmed XDR TB in 11 countries. These patients were managed during 1999-2013. For the 37 children, median age was 11 years, 32 (87%) had pulmonary TB, and 29 had a recorded HIV status; 7 (24%) were infected with HIV. Median treatment duration was 7.0 months for the intensive phase and 12.2 months for the continuation phase. Thirty (81%) children had favorable treatment outcomes. Four (11%) died, 1 (3%) failed treatment, and 2 (5%) did not complete treatment. We found a high proportion of favorable treatment outcomes among children, with mortality rates markedly lower than for adults. Regimens and duration of treatment varied considerably. Evaluation of new regimens in children is required.
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Al-Ghafli H, Al-Hajoj S. Clinical Management of Drug-resistant Mycobacterium tuberculosis Strains: Pathogen-targeted Versus Host-directed Treatment Approaches. Curr Pharm Biotechnol 2019; 20:272-284. [DOI: 10.2174/1389201019666180731120544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/19/2018] [Accepted: 07/24/2018] [Indexed: 12/13/2022]
Abstract
Background:
Despite exerted efforts to control and treat Mycobacterium tuberculosis (MTB)
strains, Tuberculosis (TB) remains a public health menace. The emergence of complex drug-resistant profiles,
such as multi-drug resistant and extensively drug-resistant MTB strains, emphasizes the need for
early diagnosis of resistant cases, shorter treatment options, and effective medical interventions.
Objective:
Solutions for better clinical management of drug-resistant cases are either pathogencentered
(novel chemotherapy agents) or host-directed approaches (modulating host immune response
to prevent MTB invasion and pathogenesis).
Results:
Despite the overall potentiality of several chemotherapy agents, it is feared that their effectiveness
could be challenged by sequential pathogen adaptation tactics. On the contrary, host-directed
therapy options might offer a long-term conceivable solution.
Conclusion:
This review discusses the main suggestions proposed so far to resolve the clinical challenges
associated with drug resistance, in the context of TB. These suggestions include novel drug delivery approaches
that could optimize treatment outcome and increase patients’ compliance to the treatment.
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Affiliation(s)
- Hawra Al-Ghafli
- Department of Infections and Immunity, King Faisal Specialist Hospital and Research Center, P.O. Box. 3354 Riyadh 11211 MBC:03, Riyadh, Saudi Arabia
| | - Sahal Al-Hajoj
- Department of Infections and Immunity, King Faisal Specialist Hospital and Research Center, P.O. Box. 3354 Riyadh 11211 MBC:03, Riyadh, Saudi Arabia
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Vasilyeva I, Mariandyshev A, Kazennyy B, Davidavičienė E, Lounis N, Keim S. Early access to bedaquiline for extensively drug-resistant (XDR) and pre-XDR tuberculosis. Eur Respir J 2019; 54:13993003.02208-2018. [DOI: 10.1183/13993003.02208-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 04/05/2019] [Indexed: 11/05/2022]
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Walker IF, Shi O, Hicks JP, Elsey H, Wei X, Menzies D, Lan Z, Falzon D, Migliori GB, Pérez-Guzmán C, Vargas MH, García-García L, Sifuentes Osornio J, Ponce-De-León A, van der Walt M, Newell JN. Analysis of loss to follow-up in 4099 multidrug-resistant pulmonary tuberculosis patients. Eur Respir J 2019; 54:13993003.00353-2018. [DOI: 10.1183/13993003.00353-2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/10/2019] [Indexed: 11/05/2022]
Abstract
Loss to follow-up (LFU) of ≥2 consecutive months contributes to the poor levels of treatment success in multidrug-resistant tuberculosis (MDR-TB) reported by TB programmes. We explored the timing of when LFU occurs by month of MDR-TB treatment and identified patient-level risk factors associated with LFU.We analysed a dataset of individual MDR-TB patient data (4099 patients from 22 countries). We used Kaplan–Meier survival curves to plot time to LFU and a Cox proportional hazards model to explore the association of potential risk factors with LFU.Around one-sixth (n=702) of patients were recorded as LFU. Median (interquartile range) time to LFU was 7 (3–11) months. The majority of LFU occurred in the initial phase of treatment (75% in the first 11 months). Major risk factors associated with LFU were: age 36–50 years (HR 1.3, 95% CI 1.0–1.6; p=0.04) compared with age 0–25 years, being HIV positive (HR 1.8, 95% CI 1.2–2.7; p<0.01) compared with HIV negative, on an individualised treatment regimen (HR 0.7, 95% CI 0.6–1.0; p=0.03) compared with a standardised regimen and a recorded serious adverse event (HR 0.5, 95% CI 0.4–0.6; p<0.01) compared with no serious adverse event.Both patient- and regimen-related factors were associated with LFU, which may guide interventions to improve treatment adherence, particularly in the first 11 months.
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Yang Z, Zhou C, Ning Z, Lu W, Zhao Q, Hu Y, Diwan VK, Xu B. High-risk screening and detection of multidrug-resistant tuberculosis in two prefectures of China: a drug susceptibility surveillance-based secondary data analysis. Glob Health Action 2019; 11:1500763. [PMID: 30203719 PMCID: PMC6136353 DOI: 10.1080/16549716.2018.1500763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In China, less than one-fifth of multidrug-resistant tuberculosis (MDR-TB) cases are detected. MDR-TB screening is conducted amongst the following five high-risk groups of TB patients: chronic cases, close contacts of MDR-TB patients, patients with treatment failure, relapsed and returned patients, and smear-positive patients at the end of the third month of initial treatment. OBJECTIVE To estimate the possibility of detecting MDR-TB cases if only the high-risk screening strategy is applied in China. METHODS A secondary analysis was applied to the surveillance-based longitudinal data of all sputum smear-positive TB patients in Prefecture E and Prefecture W of China from 2013 to 2015. The population attributable risk (PAR) was estimated using odds ratios for five risk factors/predictors and exposure proportions amongst all MDR-TB cases. RESULTS A total of 3513 TB patients (2807 from Prefecture E and 706 from Prefecture W) were included. Males accounted for 77.91% (2737/3513) of the patients. The average age was 52.5 ± 20.0 years old. Overall, 40.34% (71/176) of MDR-TB patients were from the five high-risk groups during the three-year study period. The detected proportion of MDR-TB cases using the high-risk screening strategy was significantly higher in Prefecture E than in Prefecture W. The PAR% for all five risk factors/predictors was 43.4% (95% CI: 24.6-61.7%), 49.9% (95% CI: 31.3-67.0%), and 30.3% (95% CI: 12.9-50.1%) in Prefecture E and 36.6% (95% CI: 10.4-64.5%), 13.3% (95% CI: -1.7-39.7%), and -82.5% (95% CI: -117.5--11.2%) in Prefecture W in 2013, 2014, and 2015, respectively. The PAR% for the five specific risk factors/predictors ranged from 0.4% (95% CI: -0.2-4.8%) to 21.0% (95% CI: 13.1-30.0%) in these two prefectures. CONCLUSION In general, a high-risk screening strategy would miss more than half of the MDR-TB patients because they do not belong to the five high-risk groups.
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Affiliation(s)
- Zhiqi Yang
- a Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety (Ministry of Education) , Fudan University , Shanghai , PR China
| | - Changming Zhou
- b Department of cancer prevention , Fudan University Shanghai Cancer Center , Shanghai , PR China
| | - Zhu Ning
- c Zigong Center for Disease Control and Prevention , Zigong , Sichuan , PR China
| | - Wei Lu
- d Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , Jiangsu , PR China
| | - Qi Zhao
- a Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety (Ministry of Education) , Fudan University , Shanghai , PR China
| | - Yi Hu
- a Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety (Ministry of Education) , Fudan University , Shanghai , PR China
| | - Vinod K Diwan
- e Department of Public Health Sciences (Global Health/IHCAR) , Karolinska Institutet , Stockholm , Sweden
| | - Biao Xu
- a Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety (Ministry of Education) , Fudan University , Shanghai , PR China
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Tiberi S, Torrico MM, Rahman A, Krutikov M, Visca D, Silva DR, Kunst H, Migliori GB. Managing severe tuberculosis and its sequelae: from intensive care to surgery and rehabilitation. ACTA ACUST UNITED AC 2019; 45:e20180324. [PMID: 31038649 PMCID: PMC6733754 DOI: 10.1590/1806-3713/e20180324] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/12/2019] [Indexed: 01/09/2023]
Abstract
Multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) continue to challenge physicians and public health specialists. Global treatment outcomes continue to be unsatisfactory, positive outcomes being achieved in only 54% of patients. Overall outcomes are even worse in patients infected with highly resistant strains. Treating MDR-/XDR-TB is difficult because of frequent adverse events, the long duration of drug regimens, the high costs of second-line drugs, chronic post-infectious sequelae, and loss of organ function. Ongoing research efforts (studies and trials) have various aims: increasing the rates of treatment success; understanding the potentialities of new and repurposed drugs; shortening the treatment duration; and reducing the rates of adverse events. It is hoped that better access to rapid diagnostics, increased awareness, and treatments that are more effective will reduce the rate of complications and of lung function impairment. This article aims to discuss the management of severe tuberculosis (defined as that which is potentially life threatening, requiring higher levels of care) and its sequelae, from intensive care to the postoperative period, rehabilitation, and recovery. We also discuss the nonpharmacological interventions available to manage chronic sequelae and improve patient quality of life. Because the majority of MDR-/XDR-TB cases evolve to lung function impairment (typically obstructive but occasionally restrictive), impaired quality of life, and low performance status (as measured by walk tests or other metrics), other interventions (e.g., smoking cessation, pulmonary rehabilitation, vaccination/prevention of secondary bacterial infections/exacerbations, complemented by psychological and nutritional support) are required.
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Affiliation(s)
- Simon Tiberi
- . Barts Health NHS Trust, Royal London Hospital, Division of Infection, London, United Kingdom.,. Blizard Institute, Barts and the London School of Medicine and Dentistry, Centre for Primary Care and Public Health, London, United Kingdom
| | - Marcela Muñoz Torrico
- . Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, DF, México
| | - Ananna Rahman
- . Barts Health NHS Trust, Royal London Hospital, Division of Infection, London, United Kingdom
| | - Maria Krutikov
- . Barts Health NHS Trust, Royal London Hospital, Division of Infection, London, United Kingdom
| | - Dina Visca
- . Istituti Clinici Scientifici Maugeri - IRCCS - Tradate, Italia
| | - Denise Rossato Silva
- . Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Heinke Kunst
- . Blizard Institute, Barts and the London School of Medicine and Dentistry, Centre for Primary Care and Public Health, London, United Kingdom
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Lyakurwa D, Lyimo J, Mleoh L, Riziki K, Lupinda M, Mpondo BC. Successful treatment of XDR-TB patient in Tanzania: report of the first XDR-TB patient. Trop Doct 2019; 49:224-226. [PMID: 30885056 DOI: 10.1177/0049475519833554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Drug-resistant tuberculosis (TB) is emerging as a new and serious public health challenge. We present the first case with confirmed extensive drug-resistant TB in Tanzania in a patient who had prior exposure to anti-TB drugs and a history of imprisonment in South Africa. The addition of bedaquiline to the treatment regime resulted in positive to negative sputum conversion. After a total of 30 months on treatment he was declared cured, remaining clinically stable and culture-negative throughout the follow-up. Close monitoring is important in managing drug-resistant TB cases, and good surveillance is required to detect drug-resistant TB to prevent further transmission.
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Affiliation(s)
- Dennis Lyakurwa
- 1 Programmatic Management of Drug Resistant TB (PMDT) Technical Officer, KNCV Tuberculosis Foundation, Dar Es Salaam, Tanzania
| | - Johnson Lyimo
- 2 MDR-TB Coordinator - National TB and Leprosy Program, Ministry of Health of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Liberate Mleoh
- 3 Deputy Program Manager-National TB and Leprosy Program, Ministry of Health of Health, Community Development, Gender, Elderly, and Children
| | - Kisonga Riziki
- 4 Hospital Director, Kibong'oto Infectious Disease Hospital, Sanya Juu Kilimanjaro
| | - Mrisho Lupinda
- 5 Regional TB and Leprosy coordinator - Kinondoni, Kinondoni Municipality Dar es Salaam region
| | - Bonaventura Ct Mpondo
- 6 Senior Lecturer, School of Medicine, College of Health Sciences, The University of Dodoma, Dodoma, Tanzania
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Abstract
Tuberculosis (TB) presents new challenges as a global public health problem, especially at a time of increasing threats to some particular patients due to Human Immunodeficiency Virus (HIV) infection and multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains of Mycobacterium tuberculosis. The World Health Assembly strives to reduce TB deaths by 95% and to decrease TB incidence by 95% by 2035. However, new approaches are necessary in order to attain these objectives. Such approaches include active ascertainment of cases in high risk populations, increasing the availability of accurate point-of-care testing, rapid detection of drug resistance, novel vaccines, and new prophylaxis and treatment regimens (particularly for MDR and XDR TB). The ultimate objective of those programs is to develop highly effective drug regimens that can achieve high cure rates regardless of strains’ resistance patterns.
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AlMatar M, Makky EA, AlMandeal H, Eker E, Kayar B, Var I, Köksal F. Does the Development of Vaccines Advance Solutions for Tuberculosis? Curr Mol Pharmacol 2018; 12:83-104. [PMID: 30474542 DOI: 10.2174/1874467212666181126151948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/06/2018] [Accepted: 10/17/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Mycobacterium tuberculosis (Mtb) is considered as one of the most efficacious human pathogens. The global mortality rate of TB stands at approximately 2 million, while about 8 to 10 million active new cases are documented yearly. It is, therefore, a priority to develop vaccines that will prevent active TB. The vaccines currently used for the management of TB can only proffer a certain level of protection against meningitis, TB, and other forms of disseminated TB in children; however, their effectiveness against pulmonary TB varies and cannot provide life-long protective immunity. Based on these reasons, more efforts are channeled towards the development of new TB vaccines. During the development of TB vaccines, a major challenge has always been the lack of diversity in both the antigens contained in TB vaccines and the immune responses of the TB sufferers. Current efforts are channeled on widening both the range of antigens selection and the range of immune response elicited by the vaccines. The past two decades witnessed a significant progress in the development of TB vaccines; some of the discovered TB vaccines have recently even completed the third phase (phase III) of a clinical trial. OBJECTIVE The objectives of this article are to discuss the recent progress in the development of new vaccines against TB; to provide an insight on the mechanism of vaccine-mediated specific immune response stimulation, and to debate on the interaction between vaccines and global interventions to end TB.
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Affiliation(s)
- Manaf AlMatar
- Department of Biotechnology, Institute of Natural and Applied Sciences (Fen Bilimleri Enstitusu) Cukurova University, Adana, Turkey
| | - Essam A Makky
- Department of Biotechnology, Faculty of Industrial Sciences and Technology, Universiti Malaysia Pahang (UMP), Kuantan, Malaysia
| | - Husam AlMandeal
- Freiburg Universität, Moltkestraße 90, 76133 karlsruhe Augenklinik, Germany
| | - Emel Eker
- Department of Medical Microbiology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Begüm Kayar
- Department of Medical Microbiology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Işıl Var
- Department of Food Engineering, Agricultural Faculty, Cukurova University, Adana, Turkey
| | - Fatih Köksal
- Department of Medical Microbiology, Faculty of Medicine, Cukurova University, Adana, Turkey
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Hafkin J, Hittel N, Martin A, Gupta R. Compassionate use of delamanid in combination with bedaquiline for the treatment of multidrug-resistant tuberculosis. Eur Respir J 2018; 53:13993003.01154-2018. [DOI: 10.1183/13993003.01154-2018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/12/2018] [Indexed: 11/05/2022]
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ESTIMATION OF RESERVES FOR IMPROVING THE RESULTS OF PATIENTS WITH MULTIPRESISTANT PULMONARY TUBERCULOSIS IN THE APPLICATION OF SURGICAL METHODS BASED ON ANALYSIS OF THE EFFICIENCY OF CONSERVATIVE TREATMENT OF A SPECIFIED COHORT. EUREKA: HEALTH SCIENCES 2018. [DOI: 10.21303/2504-5679.2018.00737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In order to improve the results of treatment of patients with multi-resistant pulmonary tuberculosis with the use of surgical methods, the effectiveness estimation of conservative treatment of 176 patients with this form of tuberculosis according to cohort analysis data in two districts of Kyiv were done.
In the list were included following parameters: type of the tuberculosis, its clinical-radiological form and the prevalence of the process, the results of conservative treatment in patients who completely finished the course of anti-TB chemotherapy and the results of conservative treatment of 81 patients who had indications for surgical treatment but had not been operated. Processing of the materials of the study was carried out with the use of licensed software products included in the Microsoft Office Professional 2007 package. The predicted results of treatment were calculated on the condition of surgical intervention.
Out of the total sample of patients, 31.3 % of the patients completed treatment. Mortality was 16.5 %, transferred to palliative care 11.9 %. More than one in three patients (35.2 %) stopped treatment at different times from the start.
According to the clinic of thoracic surgery SU "National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky NAMS of Ukraine ", the overall effectiveness of treatment for patients with limited multidrug-resistant tuberculosis with the use of surgical intervention is about 95 % in the absence of mortality. We have modelled the potential results of treatment of the selected cohort in case of the surgical stage is fully and timely applied in a complex of therapeutic treatment. If all 81 patients with indications for surgical treatment used that way, then, with the above efficiency, a complete cure could be predicted in 77 patients (44.5 % of the total number of observations), which in turn would allow predicting the achievement completion of treatment at 64.2 % with complete cure for 60.6 % of patients.
Thus, it is established that the positive result of surgical treatment in the general complex of treatment measures in patients with multidrug-resistant pulmonary tuberculosis is able to improve the results of treatment of this contingent more than twice, reduce the mortality almost by three times, reduce the need for repeated courses of treatment from 7.4 % to 1.7 %, as well as to reduce the epidemiological reservoir of infection due to a significant decrease in the number of patients with failure to treat tuberculosis, interrupted and palliative treatment.
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Afolabi MO. Public Health Disasters. PUBLIC HEALTH DISASTERS: A GLOBAL ETHICAL FRAMEWORK 2018; 12. [PMCID: PMC7123752 DOI: 10.1007/978-3-319-92765-7_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Public health disasters reflect the uncharted conceptual, ethical, and pragmatic intersections between public health ethics and the emerging discourse on disaster bioethics. This novel concept reflects public health issues with calamitous social consequences such as infectious disease outbreaks, the attendant public health impacts of natural or man-made disasters, and currently latent or low prevalence public health issues with the potential to rapidly acquire pandemic capacities. The attendant moral dilemmas that PHDs generate have local and global dimensions. For this reason, they demand a multifaceted ethically grounded and pragmatically oriented approach. This chapter presents the conceptual foreground to the ethical and pragmatic dimensions of these issues.
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Affiliation(s)
- Michael Olusegun Afolabi
- 0000 0001 2364 3111grid.255272.5International Journal of Ethics Education, Center for Healthcare Ethics, Duquesne University, Pittsburgh, PA USA
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35
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Matteelli A, Rendon A, Tiberi S, Al-Abri S, Voniatis C, Carvalho ACC, Centis R, D'Ambrosio L, Visca D, Spanevello A, Battista Migliori G. Tuberculosis elimination: where are we now? Eur Respir Rev 2018; 27:27/148/180035. [PMID: 29898905 DOI: 10.1183/16000617.0035-2018] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 05/15/2018] [Indexed: 11/05/2022] Open
Abstract
Tuberculosis (TB) still represents a major public health issue in spite of the significant impact of the efforts made by the World Health Organization (WHO) and partners to improve its control. In 2014 WHO launched a new global strategy (End TB) with a vision of a world free of TB, and a 2035 goal of TB elimination (defined as less than one incident case per million). The aim of this article is to summarise the theoretical bases of the End TB Strategy and to analyse progresses and persistent obstacles on the way to TB elimination.The evolution of the WHO recommended strategies of TB control (Directly Observed Therapy, Short Course (DOTS), Stop TB and End TB) are described and the concept of TB elimination is discussed. Furthermore, the eight core activities recently proposed by WHO as the milestones to achieve TB elimination are discussed in detail. Finally, the recently published experiences of Cyprus and Oman on their way towards TB elimination are described, together with the regional experience of Latin America.New prevention, diagnostic and treatment tools are also necessary to increase the speed of the present TB incidence decline.
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Affiliation(s)
- Alberto Matteelli
- University Dept of Infectious and Tropical Diseases, WHO Collaborating Centre for TB/HIV co-infection and for TB elimination, University of Brescia and Brescia Spedali Civili General Hospital, Brescia, Italy
| | - Adrian Rendon
- Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias, Hospital Universitario de Monterrey, Monterrey, México
| | - Simon Tiberi
- Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | | | - Anna Cristina C Carvalho
- Laboratory of Innovations in Therapies, Education and Bioproducts (LITEB), Oswaldo Cruz Institute (IOC), FioCruz, Rio de Janeiro, Brazil
| | - Rosella Centis
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute, IRCCS, Tradate, Italy
| | - Lia D'Ambrosio
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute, IRCCS, Tradate, Italy.,Public Health Consulting Group, Lugano, Switzerland
| | - Dina Visca
- Pneumology Dept, Maugeri Care and Research Institute, Tradate, Italy
| | - Antonio Spanevello
- Pneumology Dept, Maugeri Care and Research Institute, Tradate, Italy.,Dept of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - Giovanni Battista Migliori
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute, IRCCS, Tradate, Italy
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Mohr E, Hughes J, Reuter A, Trivino Duran L, Ferlazzo G, Daniels J, De Azevedo V, Kock Y, Steele S, Shroufi A, Ade S, Alikhanova N, Benedetti G, Edwards J, Cox H, Furin J, Isaakidis P. Delamanid for rifampicin-resistant tuberculosis: a retrospective study from South Africa. Eur Respir J 2018; 51:1800017. [PMID: 29724920 PMCID: PMC6485275 DOI: 10.1183/13993003.00017-2018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/23/2018] [Indexed: 11/05/2022]
Abstract
Experience with delamanid (Dlm) is limited, particularly among HIV-positive individuals. We describe early efficacy and safety data from a programmatic setting in South Africa.This was a retrospective cohort study of patients receiving Dlm-containing treatment regimens between November 2015 and August 2017. We report 12-month interim outcomes, sputum culture conversion (SCC) by months 2 and 6, serious adverse events (SAEs) and QT intervals corrected using the Frederica formula (QTcF).Overall, 103 patients were initiated on Dlm; 79 (77%) were HIV positive. The main indication for Dlm was intolerance to second-line anti-tuberculosis (TB) drugs (n=58, 56%). There were 12 months of follow-up for 46 patients; 28 (61%) had a favourable outcome (cure, treatment completion or culture negativity). Positive cultures were found for 57 patients at Dlm initiation; 16 out of 31 (52%) had SCC within 2 months and 25 out of 31 (81%) within 6 months. There were 67 SAEs reported in 29 patients (28%). There were four instances of QTcF prolongation >500 ms in two patients (2%), leading to permanent discontinuation in one case; however, no cardiac arrhythmias occurred.This large cohort of difficult-to-treat patients receiving Dlm for rifampicin-resistant TB treatment in a programmatic setting with high HIV prevalence had favourable early treatment response and tolerated treatment well. Dlm should remain available, particularly for those who cannot be treated with conventional regimens or with limited treatment options.
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Affiliation(s)
- Erika Mohr
- Médecins Sans Frontières, Operational Centre Brussels (OCB), Khayelitsha Project, Cape Town, South Africa
| | - Jennifer Hughes
- Médecins Sans Frontières, Operational Centre Brussels (OCB), Khayelitsha Project, Cape Town, South Africa
| | - Anja Reuter
- Médecins Sans Frontières, Operational Centre Brussels (OCB), Khayelitsha Project, Cape Town, South Africa
| | - Laura Trivino Duran
- Médecins Sans Frontières, Operational Centre Brussels (OCB), Khayelitsha Project, Cape Town, South Africa
| | - Gabriella Ferlazzo
- Médecins Sans Frontières, South African Medical Unit (SAMU), Cape Town, South Africa
| | - Johnny Daniels
- Médecins Sans Frontières, Operational Centre Brussels (OCB), Khayelitsha Project, Cape Town, South Africa
| | | | - Yulene Kock
- Provincial Government of the Western Cape Dept of Health, Cape Town, South Africa
| | - Sarah Jane Steele
- Médecins Sans Frontières, Operational Centre Brussels (OCB), Cape Town Coordination, Cape Town, South Africa
| | - Amir Shroufi
- Médecins Sans Frontières, Operational Centre Brussels (OCB), Cape Town Coordination, Cape Town, South Africa
| | - Serge Ade
- Faculty of Medicine, University of Parakou, Parakou, Benin
| | | | - Guido Benedetti
- Médecins Sans Frontières, Medical Dept (Operational Research), Operational Centre Brussels (OCB), Luxembourg City, Luxembourg
| | - Jeffrey Edwards
- Médecins Sans Frontières, Medical Dept (Operational Research), Operational Centre Brussels (OCB), Luxembourg City, Luxembourg
- Dept of Global Health, University of Washington, Seattle, WA, USA
| | - Helen Cox
- Division of Medical Microbiology and the Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Jennifer Furin
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Petros Isaakidis
- Médecins Sans Frontières, South African Medical Unit (SAMU), Cape Town, South Africa
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Olayanju O, Limberis J, Esmail A, Oelofse S, Gina P, Pietersen E, Fadul M, Warren R, Dheda K. Long-term bedaquiline-related treatment outcomes in patients with extensively drug-resistant tuberculosis from South Africa. Eur Respir J 2018; 51:13993003.00544-2018. [PMID: 29700106 DOI: 10.1183/13993003.00544-2018] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/04/2018] [Indexed: 01/08/2023]
Abstract
Optimal treatment regimens for patients with extensively drug-resistant tuberculosis (XDR-TB) remain unclear. Long-term prospective outcome data comparing XDR-TB regimens with and without bedaquiline from an endemic setting are lacking.We prospectively followed-up 272 South African patients (49.3% HIV-infected; median CD4 count 169 cells·µL-1) with newly diagnosed XDR-TB between 2008 and 2017. Outcomes were compared between those who had not received bedaquiline (pre-2013; n=204) and those who had (post-2013; n=68; 80.9% received linezolid in addition).The 24-month favourable outcome rate was substantially better in the bedaquiline versus the non-bedaquiline group (66.2% (45 out of 68) versus 13.2% (27 out of 204); p<0.001). In addition, the bedaquiline group exhibited reduced 24-month rates of treatment failure (5.9% versus 26.0%; p<0.001) and default (1.5% versus 15.2%; p<0.001). However, linezolid was withdrawn in 32.7% (18 out of 55) of patients in the bedaquiline group because of adverse events. Admission weight >50 kg, an increasing number of anti-TB drugs and bedaquiline were independent predictors of survival (the bedaquiline survival effect remained significant in HIV-infected persons, irrespective of CD4 count).XDR-TB patients receiving a backbone of bedaquiline and linezolid had substantially better favourable outcomes compared to those not using these drugs. These data inform the selection of XDR-TB treatment regimens and roll-out of newer drugs in TB-endemic countries.
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Affiliation(s)
- Olatunde Olayanju
- Lung Infection and Immunity Unit, Division of Pulmonology, Dept of Medicine, University of Cape Town, Cape Town, South Africa
| | - Jason Limberis
- Lung Infection and Immunity Unit, Division of Pulmonology, Dept of Medicine, University of Cape Town, Cape Town, South Africa
| | - Aliasgar Esmail
- Lung Infection and Immunity Unit, Division of Pulmonology, Dept of Medicine, University of Cape Town, Cape Town, South Africa
| | - Suzette Oelofse
- Lung Infection and Immunity Unit, Division of Pulmonology, Dept of Medicine, University of Cape Town, Cape Town, South Africa
| | - Phindile Gina
- Lung Infection and Immunity Unit, Division of Pulmonology, Dept of Medicine, University of Cape Town, Cape Town, South Africa
| | - Elize Pietersen
- Lung Infection and Immunity Unit, Division of Pulmonology, Dept of Medicine, University of Cape Town, Cape Town, South Africa
| | - Mohammed Fadul
- Lung Infection and Immunity Unit, Division of Pulmonology, Dept of Medicine, University of Cape Town, Cape Town, South Africa
| | - Rob Warren
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, US/SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Depts of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Keertan Dheda
- Lung Infection and Immunity Unit, Division of Pulmonology, Dept of Medicine, University of Cape Town, Cape Town, South Africa
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Affiliation(s)
- Veronika Šlachtová
- Department of Organic Chemistry; Faculty of Science; 17. listopadu 12 Olomouc Czech Republic 77146
| | - Lucie Brulíková
- Department of Medicinal Chemistry; Institute of Molecular and Translational Medicine; Hněvotínská 5 Olomouc Czech Republic 77900
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Silva DR, Dalcolmo M, Tiberi S, Arbex MA, Munoz-Torrico M, Duarte R, D'Ambrosio L, Visca D, Rendon A, Gaga M, Zumla A, Migliori GB. New and repurposed drugs to treat multidrug- and extensively drug-resistant tuberculosis. J Bras Pneumol 2018; 44:153-160. [PMID: 29791557 PMCID: PMC6044661 DOI: 10.1590/s1806-37562017000000436] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 01/18/2018] [Indexed: 11/22/2022] Open
Abstract
Multidrug-resistant and extensively drug-resistant tuberculosis (MDR-TB and XDR-TB, respectively) continue to represent a challenge for clinicians and public health authorities. Unfortunately, although there have been encouraging reports of higher success rates, the overall rate of favorable outcomes of M/XDR-TB treatment is only 54%, or much lower when the spectrum of drug resistance is beyond that of XDR-TB. Treating M/XDR-TB continues to be a difficult task, because of the high incidence of adverse events, the long duration of treatment, the high cost of the regimens used, and the drain on health care resources. Various trials and studies have recently been undertaken (some already published and others ongoing), all aimed at improving outcomes of M/XDR-TB treatment by changing the overall approach, shortening treatment duration, and developing a universal regimen. The objective of this review was to summarize what has been achieved to date, as far as new and repurposed drugs are concerned, with a special focus on delamanid, bedaquiline, pretomanid, clofazimine, carbapenems, and linezolid. After more than 40 years of neglect, greater attention has recently been paid to the need for new drugs to fight the "white plague", and promising results are being reported.
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Affiliation(s)
- Denise Rossato Silva
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Margareth Dalcolmo
- Centro de Referência Professor Hélio Fraga, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Simon Tiberi
- Division of Infection, Barts Health NHS Trust, Royal London Hospital, London, United Kingdom
| | - Marcos Abdo Arbex
- Hospital Nestor Goulart Reis, Secretaria de Estado da Saúde do Estado de São Paulo, Américo Brasiliense, SP, Brasil
| | - Marcela Munoz-Torrico
- Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, México
| | - Raquel Duarte
- Centro Hospitalar de Vila Nova de Gaia-Espinho, Porto, Portugal
| | - Lia D'Ambrosio
- Fondazione Salvatore Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Italia
| | - Dina Visca
- Division of Pulmonology, Fondazione Salvatore Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Italia
| | - Adrian Rendon
- Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias, Hospital Universitario, Universidad de Monterrey, Monterrey, Mexico
| | - Mina Gaga
- 7th Respiratory Medicine Department, Athens Chest Hospital, Athens, Greece
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, United Kingdom
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40
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Akkerman OW, Grasmeijer F, de Lange WCM, Kerstjens HAM, de Vries G, Bolhuis MS, Alffenaar JW, Frijlink HW, Smith G, Gajraj R, de Zwaan R, Hagedoorn P, Dedicoat M, van Soolingen D, van der Werf TS. Cross border, highly individualised treatment of a patient with challenging extensively drug-resistant tuberculosis. Eur Respir J 2018; 51:13993003.02490-2017. [PMID: 29419442 PMCID: PMC5863047 DOI: 10.1183/13993003.02490-2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 01/20/2018] [Indexed: 11/05/2022]
Abstract
Extensively drug-resistant (XDR) tuberculosis (TB) is defined by resistance to isoniazid, rifampicin, any fluoroquinolone and at least one of the three second line injectable drugs, such as amikacin. Drug toxicity and duration impair adherence to treatment and outcome is rather poor [1]. We report on a particularly challenging XDR-TB patient with persistent non-adherence to treatment and an exceptionally complex drug susceptibility pattern. Crossing borders by treating a patient with difficult to treat XDR-TB; highly individualised but holistic approachhttp://ow.ly/JyjK30ielsD
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Affiliation(s)
- Onno W Akkerman
- University of Groningen, University Medical Center Groningen, Dept of Pulmonary Diseases and Tuberculosis, Groningen, The Netherlands .,University of Groningen, University Medical Center Groningen, Tuberculosis Center Beatrixoord, Haren, The Netherlands.,Both authors contributed equally
| | - Floris Grasmeijer
- University of Groningen, Dept of Pharmaceutical Technology and Biopharmacy, Groningen, The Netherlands.,Both authors contributed equally
| | - Wiel C M de Lange
- University of Groningen, University Medical Center Groningen, Dept of Pulmonary Diseases and Tuberculosis, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Tuberculosis Center Beatrixoord, Haren, The Netherlands
| | - Huib A M Kerstjens
- University of Groningen, University Medical Center Groningen, Dept of Pulmonary Diseases and Tuberculosis, Groningen, The Netherlands
| | - Gerard de Vries
- KNCV Tuberculosis Foundation, Den Haag, The Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Mathieu S Bolhuis
- University of Groningen, University Medical Center Groningen, Dept of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
| | - Jan-Willem Alffenaar
- University of Groningen, University Medical Center Groningen, Dept of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
| | - Henderik W Frijlink
- University of Groningen, Dept of Pharmaceutical Technology and Biopharmacy, Groningen, The Netherlands
| | - Grace Smith
- National Mycobacteriology Reference Unit, Birmingham, UK
| | | | - Rina de Zwaan
- National Tuberculosis Reference Laboratory, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Paul Hagedoorn
- University of Groningen, Dept of Pharmaceutical Technology and Biopharmacy, Groningen, The Netherlands
| | - Martin Dedicoat
- Dept of Infection, Heart of England Foundation Trust, Birmingham, UK
| | - Dick van Soolingen
- National Tuberculosis Reference Laboratory, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Radboud University Nijmegen Medical Centre, Depts of Pulmonary Diseases and Medical Microbiology, Nijmegen, The Netherlands
| | - Tjip S van der Werf
- University of Groningen, University Medical Center Groningen, Dept of Pulmonary Diseases and Tuberculosis, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Dept of Internal Medicine, Groningen, The Netherlands
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41
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Kim CT, Kim TO, Shin HJ, Ko YC, Hun Choe Y, Kim HR, Kwon YS. Bedaquiline and delamanid for the treatment of multidrug-resistant tuberculosis: a multicentre cohort study in Korea. Eur Respir J 2018; 51:13993003.02467-2017. [DOI: 10.1183/13993003.02467-2017] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/09/2018] [Indexed: 11/05/2022]
Abstract
Relatively little is known about the efficacy and safety of the programmatic use of bedaquiline and delamanid in multidrug-resistant tuberculosis (MDR-TB) treatment.This study evaluated 61 patients with MDR-TB treated with bedaquiline (n=39), delamanid (n=11) or both, either sequentially (n=10) or in coadministration (n=1), for >1 month, combined with a World Health Organization-recommended regimen.Of these, 49 (80.3%) were male and 12 (19.7%) were female. The median (interquartile range (IQR)) age was 53 (38.5–61.0) years. 42 (68.9%) patients had fluoroquinolone-resistant MDR-TB and 16 (26.2%) had extensively drug-resistant TB. The median (IQR) duration of treatment with bedaquiline and/or delamanid was 168 (166.5–196.5) days, with 33 (54.1%) receiving linezolid for a median (IQR) of 673 (171–736) days. Of the 55 patients with positive sputum cultures at the start of bedaquiline and/or delamanid treatment, 39 (70.9%) achieved sputum culture conversion within a median of 119 days. Treatment was halted in four patients (6.6%) because of prolonged Fridericia's corrected QT interval.Bedaquiline and delamanid were effective and safe for treating MDR-TB, with initial evidence of sequential administration of these two drugs as a viable treatment strategy for patients when an adequate treatment regimen cannot be constructed.
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42
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Drug-resistant Mycobacterium tuberculosis: Epidemiology and role of morphological alterations. J Glob Antimicrob Resist 2018; 12:192-196. [DOI: 10.1016/j.jgar.2017.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 09/30/2017] [Accepted: 10/07/2017] [Indexed: 02/03/2023] Open
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Cabibbe AM, Sotgiu G, Izco S, Migliori GB. Genotypic and phenotypic M. tuberculosis resistance: guiding clinicians to prescribe the correct regimens. Eur Respir J 2017; 50:50/6/1702292. [DOI: 10.1183/13993003.02292-2017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/11/2017] [Indexed: 11/05/2022]
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D'Ambrosio L, Bothamley G, Caminero Luna JA, Duarte R, Guglielmetti L, Muñoz Torrico M, Payen MC, Saavedra Herrera N, Salazar Lezama MA, Skrahina A, Tadolini M, Tiberi S, Veziris N, Migliori GB. Team approach to manage difficult-to-treat TB cases: Experiences in Europe and beyond. Pulmonology 2017; 24:132-141. [PMID: 29229274 DOI: 10.1016/j.rppnen.2017.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/29/2017] [Indexed: 01/17/2023] Open
Abstract
As recommended by the World Health Organization (WHO), optimal management of MDR-TB cases can be ensured by a multi-speciality consultation body known as 'TB Consilium'. This body usually includes different medical specialities, competences and perspectives (e.g., clinical expertise both for adults and children; surgical, radiological and public health expertise; psychological background and nursing experience, among others), thus lowering the risk of making mistakes - or managing the patients inappropriately, in order to improve their clinical outcomes. At present, several high MDR-TB burden countries in the different WHO regions (and beyond) have introduced TB Consilium-like bodies at the national or subnational level to reach consensus on the best treatment approach for their patients affected by TB. In addition, in countries/settings where a formal system of consultation does not exist, specialized staff from MDR-TB reference centres or international organizations usually spend a considerable amount of their working time responding to phone or e-mail clinical queries on how to manage M/XDR-TB cases. The aim of this manuscript is to describe the different experiences with the TB Consilia both at the international level (European Respiratory Society - ERS/WHO TB Consilium) and in some of the countries where this experience operates successfully in Europe and beyond. The Consilium experiences are described around the following topics: (1) history, aims and focus; (2) management and funding; (3) technical functioning and structure; (4) results achieved. In addition a comparative analysis of the TB Consilia in the different countries has been performed.
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Affiliation(s)
- L D'Ambrosio
- WHO Collaborating Centre for TB and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy; Public Health Consulting Group, Lugano, Switzerland.
| | - G Bothamley
- Homerton University Hospital, London, United Kingdom.
| | - J A Caminero Luna
- Pneumology Department, Hospital General de Gran Canaria "Dr. Negrin", Las Palmas de Gran Canaria, Spain; MDR-TB Unit, Tuberculosis Division, International Union against Tuberculosis and Lung Disease The Union, Paris, France.
| | - R Duarte
- National Reference Centre for MDR-TB, Hospital Centre Vila Nova de Gaia, Department of Pneumology, Public Health Science and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - L Guglielmetti
- Sorbonne Universités, UPMC Univ Paris 06, CR7, INSERM U1135, Centre d'Immunologie et des Maladies Infectieuses, CIMI, F-75013 Paris, France; AP-HP, Hôpitaux Universitaires de l'Est Parisien, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, F-75013 Paris, France.
| | - M Muñoz Torrico
- Tuberculosis Clinic, National Institute of Respiratory Diseases of Mexico (INER), Mexico City, Mexico.
| | - M C Payen
- Division of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles ULB, Brussels, Belgium.
| | | | - M A Salazar Lezama
- Tuberculosis Clinic, National Institute of Respiratory Diseases of Mexico (INER), Mexico City, Mexico.
| | - A Skrahina
- Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus.
| | - M Tadolini
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.
| | - S Tiberi
- Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom; Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, United Kingdom.
| | - N Veziris
- Sorbonne Universités, UPMC Univ Paris 06, CR7, INSERM U1135, Centre d'Immunologie et des Maladies Infectieuses, CIMI, F-75013 Paris, France; AP-HP, Hôpitaux Universitaires de l'Est Parisien, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, F-75013 Paris, France
| | - G B Migliori
- WHO Collaborating Centre for TB and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy.
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Li L, Jin Y, Wang B, Yang Z, Liu M, Guo H, Zhang J, Lu Y. A structure-based strategy toward the development of novel candidates for antimycobacterial activity: Synthesis, biological evaluation, and docking study. Chem Biol Drug Des 2017; 91:769-780. [DOI: 10.1111/cbdd.13142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/18/2017] [Accepted: 11/01/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Linhu Li
- Institute of Medicinal Biotechnology; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Yuanyuan Jin
- Institute of Medicinal Biotechnology; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Bin Wang
- Beijing Key Laboratory of Drug Resistance Tuberculosis Research; Department of Pharmacology; Beijing Tuberculosis and Thoracic Tumor Research Institute; Beijing Chest Hospital; Capital Medical University; Beijing China
| | - Zhaoyong Yang
- Institute of Medicinal Biotechnology; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Mingliang Liu
- Institute of Medicinal Biotechnology; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Huiyuan Guo
- Institute of Medicinal Biotechnology; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Jun Zhang
- Institute of Medicinal Biotechnology; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
- Zhejiang Starry Pharmaceutical Co. Ltd.; Xianju China
| | - Yu Lu
- Beijing Key Laboratory of Drug Resistance Tuberculosis Research; Department of Pharmacology; Beijing Tuberculosis and Thoracic Tumor Research Institute; Beijing Chest Hospital; Capital Medical University; Beijing China
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46
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Miotto P, Tessema B, Tagliani E, Chindelevitch L, Starks AM, Emerson C, Hanna D, Kim PS, Liwski R, Zignol M, Gilpin C, Niemann S, Denkinger CM, Fleming J, Warren RM, Crook D, Posey J, Gagneux S, Hoffner S, Rodrigues C, Comas I, Engelthaler DM, Murray M, Alland D, Rigouts L, Lange C, Dheda K, Hasan R, Ranganathan UDK, McNerney R, Ezewudo M, Cirillo DM, Schito M, Köser CU, Rodwell TC. A standardised method for interpreting the association between mutations and phenotypic drug resistance in Mycobacterium tuberculosis. Eur Respir J 2017; 50:1701354. [PMID: 29284687 PMCID: PMC5898944 DOI: 10.1183/13993003.01354-2017] [Citation(s) in RCA: 228] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/13/2017] [Indexed: 11/24/2022]
Abstract
A clear understanding of the genetic basis of antibiotic resistance in Mycobacterium tuberculosis is required to accelerate the development of rapid drug susceptibility testing methods based on genetic sequence.Raw genotype-phenotype correlation data were extracted as part of a comprehensive systematic review to develop a standardised analytical approach for interpreting resistance associated mutations for rifampicin, isoniazid, ofloxacin/levofloxacin, moxifloxacin, amikacin, kanamycin, capreomycin, streptomycin, ethionamide/prothionamide and pyrazinamide. Mutation frequencies in resistant and susceptible isolates were calculated, together with novel statistical measures to classify mutations as high, moderate, minimal or indeterminate confidence for predicting resistance.We identified 286 confidence-graded mutations associated with resistance. Compared to phenotypic methods, sensitivity (95% CI) for rifampicin was 90.3% (89.6-90.9%), while for isoniazid it was 78.2% (77.4-79.0%) and their specificities were 96.3% (95.7-96.8%) and 94.4% (93.1-95.5%), respectively. For second-line drugs, sensitivity varied from 67.4% (64.1-70.6%) for capreomycin to 88.2% (85.1-90.9%) for moxifloxacin, with specificity ranging from 90.0% (87.1-92.5%) for moxifloxacin to 99.5% (99.0-99.8%) for amikacin.This study provides a standardised and comprehensive approach for the interpretation of mutations as predictors of M. tuberculosis drug-resistant phenotypes. These data have implications for the clinical interpretation of molecular diagnostics and next-generation sequencing as well as efficient individualised therapy for patients with drug-resistant tuberculosis.
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Affiliation(s)
- Paolo Miotto
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Belay Tessema
- Department of Medical Microbiology, University of Gondar, Gondar, Ethiopia
| | - Elisa Tagliani
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Angela M Starks
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Claudia Emerson
- Institute on Ethics & Policy for Innovation, Department of Philosophy, McMaster University, Hamilton, ON, Canada
| | | | - Peter S Kim
- Office of AIDS Research, National Institutes of Health, Rockville, MD, USA
| | | | - Matteo Zignol
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Christopher Gilpin
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Stefan Niemann
- Molecular and Experimental Mycobacteriology, Priority Area Infections, Research Center Borstel, Borstel, Germany
- German Center for Infection Research, Borstel, Germany
| | - Claudia M Denkinger
- Foundation for Innovative New Diagnostics, Campus Biotech, Geneva, Switzerland
| | - Joy Fleming
- Key Laboratory of RNA Biology, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Robin M Warren
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Derrick Crook
- Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
- National Infection Service, Public Health England, London, UK
| | - James Posey
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sebastien Gagneux
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sven Hoffner
- Microbiology, Tumour and Cell Biology, Karolinska Institute, Stockholm, Sweden
- Public Health Agency of Sweden, Solna, Sweden
| | | | - Iñaki Comas
- Tuberculosis Genomics Unit, Biomedicine Institute of Valencia (IBV-CSIC), Valencia, Spain
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Community (FISABIO), Valencia, Spain
- CIBER (Centros de Investigación Biomédica en Red) in Epidemiology and Public Health, Madrid, Spain
| | | | - Megan Murray
- Harvard School of Public Health, Department of Epidemiology, Boston, MA, USA
| | - David Alland
- Center for Emerging Pathogens, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Leen Rigouts
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Christoph Lange
- Division of Clinical Infectious Diseases and German Center for Infection Research Tuberculosis Unit, Research Center Borstel, Borstel, Germany
- International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
- Department of Internal Medicine, University of Namibia School of Medicine, Windhoek, Namibia
| | - Keertan Dheda
- Lung Infection and Immunity Unit, Department of Medicine, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Rumina Hasan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Ruth McNerney
- Department of Medicine, Division of Pulmonology, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | | | - Daniela M Cirillo
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Claudio U Köser
- Department of Genetics, University of Cambridge, Cambridge, UK
| | - Timothy C Rodwell
- Foundation for Innovative New Diagnostics, Campus Biotech, Geneva, Switzerland
- Department of Medicine, University of California, San Diego, CA, USA
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Pang Y, Lu J, Huo F, Ma Y, Zhao L, Li Y, Liang Q, Chu N, Gao M, Huang H. Prevalence and treatment outcome of extensively drug-resistant tuberculosis plus additional drug resistance from the National Clinical Center for Tuberculosis in China: A five-year review. J Infect 2017; 75:433-440. [PMID: 28804028 DOI: 10.1016/j.jinf.2017.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 08/01/2017] [Accepted: 08/03/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The objective of this study was to explore the prevalence and primary clinical outcomes of extensively drug-resistant tuberculosis plus addition resistance to all drug tested (XDR-TB-Plus) between 2011 and 2015 in Beijing Chest Hospital. METHODS We retrospectively reviewed the drug susceptibility testing (DST) results of clinical Mycobacterium tuberculosis (MTB) strains from TB patients seeking health care in the National Clinical Center for Tuberculosis, between 2011 and 2015. The medical records of patients classified as XDR-TB-Plus were reviewed, including demographic characteristics, treatment regimen, and treatment outcome. RESULTS Of 9544 MTB isolates, there were 3376 (35.4%), 842 (8.8%) and 61 (0.64%) isolates identified as multidrug resistant tuberculosis (MDR-TB), extensively drug resistant tuberculosis (XDR-TB) and XDR-TB-Plus, respectively. The proportion of XDR-TB showed significant increase from 6.3% in 2011 to 9.1% in 2015 (Chi-square trend 5.94, P = 0.015). Similarly, the proportion of XDR-TB-Plus seemed to increase from 0.46% in 2011 to 0.74% in 2015, while the increasing trend was not significant (Chi-square trend 1.50, P = 0.221). The most frequently prescribed anti-TB drug was moxifloxacin (18/29, 62.1%), followed by protionamide (16/29, 55.2%), clofazimine (15/29, 51.7%), and pyrazinamide (15/29, 51.7%). Patients receiving regimens containing linezolid (LZD) were almost 27 times more likely to have favorable treatment outcome compared with those receiving regimens without LZD [odds ratios = 27.00; 95% CI = 2.50-291.19; P = 0.003]. CONCLUSIONS In conclusion, our data have demonstrated that the proportion of XDR-TB has significantly increased over the past five years in Beijing Chest Hospital. In addition, the XDR-TB-Plus patients were more likely to reach favorable clinical outcome under the treatment of regimen containing LZD.
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Affiliation(s)
- Yu Pang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Jie Lu
- Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Fengmin Huo
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Yifeng Ma
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Liping Zhao
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Yunxu Li
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Qian Liang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China
| | - Naihui Chu
- Department of Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China.
| | - Mengqiu Gao
- Department of Tuberculosis, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China.
| | - Hairong Huang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China.
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48
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D'Ambrosio L, Tadolini M, Centis R, Chalmers JD, Migliori GB. A new free-cost e-service supporting clinicians to manage their difficult-to-treat tuberculosis cases: The European Respiratory Society-World Health Organization tuberculosis Consilium. Indian J Med Res 2017; 145:261-263. [PMID: 28749387 PMCID: PMC5555053 DOI: 10.4103/ijmr.ijmr_37_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Lia D'Ambrosio
- World Health Organization Collaborating Centre for Tuberculosis & Lung Diseases, Maugeri Care & Research Institute, Tradate, Italy; Public Health Consulting Group, Lugano, Switzerland
| | - Marina Tadolini
- Department of Medical & Surgical Sciences, Unit of Infectious Diseases, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Rosella Centis
- World Health Organization Collaborating Centre for Tuberculosis & Lung Diseases, Maugeri Care & Research Institute, Tradate, Italy
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK
| | - Giovanni Battista Migliori
- World Health Organization Collaborating Centre for Tuberculosis & Lung Diseases, Maugeri Care & Research Institute, Tradate, Italy
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Ahmad Khan F, Salim MH, du Cros P, Casas EC, Khamraev A, Sikhondze W, Benedetti A, Bastos M, Lan Z, Jaramillo E, Falzon D, Menzies D. Effectiveness and safety of standardised shorter regimens for multidrug-resistant tuberculosis: individual patient data and aggregate data meta-analyses. Eur Respir J 2017; 50:50/1/1700061. [DOI: 10.1183/13993003.00061-2017] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/15/2017] [Indexed: 11/05/2022]
Abstract
We assessed the effectiveness and safety of standardised, shorter multidrug-resistant tuberculosis (MDR-TB) regimens by pooling data from observational studies.Published studies were identified from medical databases; unpublished studies were identified from expert consultation. We conducted aggregate data meta-analyses to estimate pooled proportions of treatment outcomes and individual patient data (IPD) meta-regression to identify risk factors for unsuccessful treatment in patients treated with 9- to 12-month MDR-TB regimens composed of a second-line injectable, gatifloxacin/moxifloxacin, prothionamide, clofazimine, isoniazid, pyrazinamide and ethambutol.We included five studies in which 796 out of 1279 (62.2%) individuals with confirmed MDR-TB (98.4%) or rifampin-resistant TB (1.6%), and not previously exposed to second-line drugs, were eligible for shorter regimens. 669 out of 796 participants were successfully treated (83.0%, 95% CI 71.9–90.3%). In IPD meta-regression (three studies, n=497), failure/relapse was associated with fluoroquinolone resistance (crude OR 46, 95% CI 8–273), pyrazinamide resistance (OR 8, 95% CI 2–38) and no culture conversion by month 2 of treatment (OR 7, 95% CI 3–202). Two participants acquired extensive drug resistance. Four studies reported grade 3 or 4 adverse events in 55 out of 304 (18.1%) participants.Shorter regimens were effective in treating MDR-TB; however, there is uncertainty surrounding the generalisability of the high rate of treatment success to less selected populations, to programmatic settings and in the absence of drug susceptibility tests to key component drugs.
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50
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Hafkin J, Hittel N, Martin A, Gupta R. Early outcomes in MDR-TB and XDR-TB patients treated with delamanid under compassionate use. Eur Respir J 2017; 50:50/1/1700311. [PMID: 28751415 PMCID: PMC5898945 DOI: 10.1183/13993003.00311-2017] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/24/2017] [Indexed: 11/26/2022]
Abstract
Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) remain significant global health challenges, with an annual incidence of approximately 480 000 and 46 000 cases, respectively [1]. Treatment outcomes in MDR-TB patients remain poor overall (52% success) and outcomes in XDR-TB patients are even more dismal (28% success) [1–3]. To improve these outcomes, new drugs are needed [4]. Delamanid, a nitroimidazooxazole agent that has been included in the guidelines for MDR-TB treatment by the World Health Organization (WHO), has been shown to improve two-month sputum culture conversion (SCC) and long-term treatment outcomes, when added to an optimised background regimen (OBR) in MDR-TB patients [5–7]. As part of a global access initiative, Otsuka Pharmaceutical Co., Ltd. in coordination with the European Respiratory Society (ERS)/WHO TB Consilium, and Médecins Sans Frontières/Partners in Health (MSF-PIH) established its first Compassionate Use (CU) programme in February 2014 to provide patients with very limited treatment options access to delamanid. We present here early safety and efficacy outcomes of patients enrolled in this effort. Early data from the CU programme show delamanid may be effective in MDR/XDR-TB with few treatment optionshttp://ow.ly/tA6Y30cs2Yg
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Affiliation(s)
- Jeffrey Hafkin
- Otsuka Pharmaceutical Development and Commercialization Inc., Rockville, MD, USA
| | | | | | - Rajesh Gupta
- Otsuka Pharmaceutical Development and Commercialization Inc., Rockville, MD, USA
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