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Marwitz F, Hädrich G, Redinger N, Besecke KFW, Li F, Aboutara N, Thomsen S, Cohrs M, Neumann PR, Lucas H, Kollan J, Hozsa C, Gieseler RK, Schwudke D, Furch M, Schaible U, Dailey LA. Intranasal Administration of Bedaquiline-Loaded Fucosylated Liposomes Provides Anti-Tubercular Activity while Reducing the Potential for Systemic Side Effects. ACS Infect Dis 2024; 10:3222-3232. [PMID: 39136125 PMCID: PMC11406518 DOI: 10.1021/acsinfecdis.4c00192] [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: 09/14/2024]
Abstract
Liposomal formulations of antibiotics for inhalation offer the potential for the delivery of high drug doses, controlled drug release kinetics in the lung, and an excellent safety profile. In this study, we evaluated the in vivo performance of a liposomal formulation for the poorly soluble, antituberculosis agent, bedaquiline. Bedaquiline was encapsulated within monodisperse liposomes of ∼70 nm at a relatively high drug concentration (∼3.6 mg/mL). Formulations with or without fucose residues, which bind to C-type lectin receptors and mediate a preferential binding to macrophage mannose receptor, were prepared, and efficacy was assessed in an in vivo C3HeB/FeJ mouse model of tuberculosis infection (H37Rv strain). Seven intranasal instillations of 5 mg/kg bedaquiline formulations administered every second day resulted in a significant reduction in lung burden (∼0.4-0.6 Δlog10 CFU), although no differences between fucosylated and nonfucosylated formulations were observed. A pharmacokinetic study in healthy, noninfected Balb/c mice demonstrated that intranasal administration of a single dose of 2.5 mg/kg bedaquiline liposomal formulation (fucosylated) improved the lung bioavailability 6-fold compared to intravenous administration of the same formulation at the same dose. Importantly, intranasal administration reduced systemic concentrations of the primary metabolite, N-desmethyl-bedaquiline (M2), compared with both intravenous and oral administration. This is a clinically relevant finding as the M2 metabolite is associated with a higher risk of QT-prolongation in predisposed patients. The results clearly demonstrate that a bedaquiline liposomal inhalation suspension may show enhanced antitubercular activity in the lung while reducing systemic side effects, thus meriting further nonclinical investigation.
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Affiliation(s)
- Franziska Marwitz
- Bioanalytical Chemistry, Research Center Borstel, Leibniz Lung Center, Parkallee 1-40, Borstel 23845, Germany
- German Center for Infection Research, Thematic Translational Unit Tuberculosis, Borstel 23845, Germany
| | - Gabriela Hädrich
- Department of Pharmaceutical Sciences, University of Vienna, Josef-Holaubek-Platz 2 ,Vienna 1090, Austria
- Institute of Pharmacy, Martin-Luther-Universität Halle-Wittenberg, Kurt-Mothes-Str. 3, Halle/Saale 06120, Germany
| | - Natalja Redinger
- Cellular Microbiology, Research Center Borstel, Leibniz Lung Center, Parkallee 1-40 ,Borstel 23845, Germany
| | - Karen F W Besecke
- Rodos Biotarget GmbH, Feodor-Lynen-Straße 31, Hannover 30625, Germany
- Siegfried Hameln GmbH, Langes Feld 13 ,Hameln 31789, Germany
- Cardior Pharmaceuticals GmbH, Hollerithallee 20 ,Hannover 30419, Germany
| | - Feng Li
- Department of Pharmaceutical Sciences, University of Vienna, Josef-Holaubek-Platz 2 ,Vienna 1090, Austria
- Institute of Pharmacy, Martin-Luther-Universität Halle-Wittenberg, Kurt-Mothes-Str. 3, Halle/Saale 06120, Germany
- Vienna Doctoral School of Pharmaceutical, Nutritional and Sport Sciences (PhaNuSpo), University of Vienna, Josef-Holaubek-Platz 2 ,Vienna 1090, Austria
| | - Nadine Aboutara
- Bioanalytical Chemistry, Research Center Borstel, Leibniz Lung Center, Parkallee 1-40, Borstel 23845, Germany
- German Center for Infection Research, Thematic Translational Unit Tuberculosis, Borstel 23845, Germany
| | - Simone Thomsen
- Bioanalytical Chemistry, Research Center Borstel, Leibniz Lung Center, Parkallee 1-40, Borstel 23845, Germany
| | - Michaela Cohrs
- Institute of Pharmacy, Martin-Luther-Universität Halle-Wittenberg, Kurt-Mothes-Str. 3, Halle/Saale 06120, Germany
- General Biochemistry and Physical Pharmacy, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460 ,Ghent 9000, Belgium
| | - Paul Robert Neumann
- Institute of Pharmacy, Martin-Luther-Universität Halle-Wittenberg, Kurt-Mothes-Str. 3, Halle/Saale 06120, Germany
| | - Henrike Lucas
- Institute of Pharmacy, Martin-Luther-Universität Halle-Wittenberg, Kurt-Mothes-Str. 3, Halle/Saale 06120, Germany
| | - Julia Kollan
- Institute of Pharmacy, Martin-Luther-Universität Halle-Wittenberg, Kurt-Mothes-Str. 3, Halle/Saale 06120, Germany
| | - Constantin Hozsa
- Rodos Biotarget GmbH, Feodor-Lynen-Straße 31, Hannover 30625, Germany
- Siegfried Hameln GmbH, Langes Feld 13 ,Hameln 31789, Germany
| | - Robert K Gieseler
- Rodos Biotarget GmbH, Feodor-Lynen-Straße 31, Hannover 30625, Germany
- Department of Medicine, University Hospital, Knappschaftskrankenhaus Bochum, Ruhr University Bochum, In der Schornau 23-25 ,Bochum 44892, Germany
| | - Dominik Schwudke
- Bioanalytical Chemistry, Research Center Borstel, Leibniz Lung Center, Parkallee 1-40, Borstel 23845, Germany
- German Center for Infection Research, Thematic Translational Unit Tuberculosis, Borstel 23845, Germany
- German Center for Lung Research (DZL), Airway Research Center North (ARCN), Research Center Borstel, Leibniz Lung Center, Borstel 23845, Germany
- Kiel Nano, Surface and Interface Sciences (KiNSIS), Kiel University, Kiel 24118, Germany
| | - Marcus Furch
- Rodos Biotarget GmbH, Feodor-Lynen-Straße 31, Hannover 30625, Germany
- Certmedica International GmbH, Magnolienweg 17 ,Aschaffenburg 63741, Germany
| | - Ulrich Schaible
- German Center for Infection Research, Thematic Translational Unit Tuberculosis, Borstel 23845, Germany
- Cellular Microbiology, Research Center Borstel, Leibniz Lung Center, Parkallee 1-40 ,Borstel 23845, Germany
| | - Lea Ann Dailey
- Department of Pharmaceutical Sciences, University of Vienna, Josef-Holaubek-Platz 2 ,Vienna 1090, Austria
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Khan A, Khan AH, Ahmad N, Ghafoor A. Effectiveness of bedaquiline containing all oral longer regimens in treating multidrug/rifampicin resistant tuberculosis in Pakistan. J Infect Public Health 2024; 17:102522. [PMID: 39173557 DOI: 10.1016/j.jiph.2024.102522] [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: 02/27/2024] [Revised: 08/10/2024] [Accepted: 08/12/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Despite the introduction of bedaquiline (Bdq) containing all-oral regimens for treating patients with rifampicin resistant/multidrug resistant tuberculosis (MDR/RR-TB) in 2019, data on its effectiveness in Pakistan, which has the fifth highest MDR-TB burden, is lacking. This study evaluates treatment outcomes and identifies factors associated with unsuccessful outcomes among MDR/RR-TB patients treated with an all-oral longer treatment regimen (LTR). METHODS This retrospective record review included all microbiologically confirmed pulmonary MDR/RR-TB patients treated with an all-oral LTR between August 2019 and February 2021 across nine PMDT centres in Pakistan. Sociodemographic and clinical data were retrieved from the Electronic Nominal Recording and Reporting System. Treatment outcomes, defined by WHO criteria, were analysed using SPSS and multivariate binary logistic regression to identify factors associated with unsuccessful outcomes. A p-value < 0.05 was considered statistically significant. RESULTS The final analysis included 644 MDR/RR-TB patients (mean age 37.9 ± 17.6 years), mostly male (53.0 %), underweight (68.0 %), with TB treatment history (66.1 %), MDR-TB (84.9 %), lung cavitation (71.0 %), and no comorbidities (86.4 %). Fluoroquinolone resistance was found in 41.9 %, 16 % had used second-line drugs, and 9.8 % had previous MDR-TB treatment. A total of 400 (62.1 %) patients were declared cured, 53 (8.2 %) treatment completed, 117 (18.2 %) died, 37 (5.7 %) lost to follow-up (LTFU), and 37 (5.7 %) treatment failures. Overall treatment success rate was 70.3 % (n = 453). In multivariate analysis, history of TB treatment (OR:1.63, 95 %CI:1.09-2.64, p = 0.023), previous SLD use (OR:2.09, 95 %CI: 1.20-3.37, p = 0.012), resistance to Z (OR:0.43, 95 %CI: 0.20-0.81, p = 0.023), and resistance to > 5 drugs (OR:3.12, 95 %CI:1.36-11.64, p = 0.013) were significantly associated with death and treatment failure. Whereas, lung cavitation had statistically significant association with LTFU (OR:2.66, 95 %CI:1.10-7.32, p = 0.045). CONCLUSION Treatment success rate (70.3 %) in this study fell below the WHO recommended target success rate (>90 %). Enhanced clinical management, coupled with special attention to patients exhibiting identified risk factors could improve treatment outcomes.
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Affiliation(s)
- Asad Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia.
| | - Nafees Ahmad
- Department of Pharmacy Practice, Faculty of Biological, Pharmaceutical and Health Sciences, University of Balochistan, Quetta, Pakistan
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Schönfeld N, Barkane L, Davoliene I, Danilovits M, Miliauskas S, Ader F, Kon OM, Lange C, Duvignaud A, Heiss-Neumann M, Hittel N, Lazarević N, Knebel I, Martin A, Eschenbach B, van Heumen E, George V. Real-life use of delamanid: results from the European post-authorisation safety study. IJTLD OPEN 2024; 1:274-278. [PMID: 39021446 PMCID: PMC11249655 DOI: 10.5588/ijtldopen.24.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/23/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND A post-authorisation safety study (PASS) on delamanid (DLM) was conducted as part of a post-approval commitment to the European Medicines Agency. The aim of this study was to evaluate the use of DLM in a real-life setting, its safety, and treatment outcomes in patients with multidrug-resistant TB (MDR-TB). METHODS This was a prospective, multicentric, non-interventional study conducted in the European Union. MDR-TB Regimen selection and patient monitoring were conducted in accordance with existing medical practices. Data on the use of DLM, related adverse events, and treatment outcomes were collected for up to 30 months after the first DLM dose. Descriptive summary statistics were used for continuous and categorical variables. RESULTS Out of 86 patients, one had extrapulmonary TB. Two-thirds of the patients were treated with DLM for more than 24 weeks. The most frequent adverse drug reaction to DLM was QT interval prolongation. Resistance to DLM was detected in one patient during treatment. The treatment success rate was 77%. CONCLUSION No new safety concerns were revealed, including in patients treated with DLM for more than 24 weeks. QT interval prolongations were well managed and did not lead to any clinically significant cardiac effects. The treatment outcomes were in line with the WHO target for Europe.
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Affiliation(s)
- N Schönfeld
- Helios Klinikum Emil von Behring, Berlin, Germany
| | - L Barkane
- Riga East University Hospital, Riga, Latvia
| | - I Davoliene
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | - S Miliauskas
- Department of Pulmonology, Lithuania University of Health Sciences, Kaunas, Lithuania
| | - F Ader
- Hospices Civils de Lyon, Département des Maladies Infectieuses et Tropicales, Lyon, France
| | - O M Kon
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - C Lange
- Research Center Borstel, Leibniz Lung Center, Borstel, Germany
- Tuberculosis Unit, German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel Riems, Borstel, Germany
- Respiratory Medicine & International Health, University Lübeck, Lübeck, Germany
- Baylor College of Medicine and Texas Children´s Hospital, Global TB Program, Houston, TX, USA
| | - A Duvignaud
- Department of Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de Bordeaux-Groupe Hospitalier Pellegrin, Bordeaux, France
| | | | - N Hittel
- Otsuka Novel Products, Munich, Germany
| | | | - I Knebel
- Otsuka Novel Products, Munich, Germany
| | - A Martin
- Otsuka Novel Products, Munich, Germany
| | | | | | - V George
- Otsuka Pharmaceutical Development and Commercialization, Princeton, NJ, USA
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4
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Zhong X, Lin A, Luo J, Li Y, Chen J, Ning C, Cao F. Clinical research progress of novel antituberculosis drugs on multidrug-resistant tuberculosis. Postgrad Med J 2024; 100:366-372. [PMID: 38200633 DOI: 10.1093/postmj/qgad140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/05/2023] [Accepted: 12/10/2023] [Indexed: 01/12/2024]
Abstract
Multidrug-resistant tuberculosis (MDR-TB) has become a critical challenge to public health, and the prevention and treatment of MDR-TB are of great significance in reducing the global burden of tuberculosis. How to improve the effectiveness and safety of chemotherapy for MDR-TB is a pressing issue that needs to be addressed in tuberculosis control efforts. This article provides a comprehensive review of the clinical application of new antituberculosis drugs in MDR-TB, aiming to provide a scientific basis for the prevention and treatment strategy of MDR-TB.
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Affiliation(s)
- Xinxin Zhong
- Department of Pulmonary and Critical Care Medicine, Red Cross Hospital of Yulin City, Yulin, Guangxi 537000, China
| | - Ao Lin
- Department of Cardiothoracic Surgery, Red Cross Hospital of Yulin City, Yulin, Guangxi 537000, China
| | - Jian Luo
- Department of Pulmonary and Critical Care Medicine, Red Cross Hospital of Yulin City, Yulin, Guangxi 537000, China
| | - Yeqin Li
- Department of Pulmonary and Critical Care Medicine, Red Cross Hospital of Yulin City, Yulin, Guangxi 537000, China
| | - Jinlan Chen
- Department of Pulmonary and Critical Care Medicine, Red Cross Hospital of Yulin City, Yulin, Guangxi 537000, China
| | - Chao Ning
- Department of Pulmonary and Critical Care Medicine, Red Cross Hospital of Yulin City, Yulin, Guangxi 537000, China
| | - Fu Cao
- Department of Pulmonary and Critical Care Medicine, Red Cross Hospital of Yulin City, Yulin, Guangxi 537000, China
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5
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Mikiashvili L, Kempker RR, Chakhaia TS, Bablishvili N, Avaliani Z, Lomtadze N, Schechter MC, Kipiani M. Impact of Prior Tuberculosis Treatment With New/Companion Drugs on Clinical Outcomes in Patients Receiving Concomitant Bedaquiline and Delamanid for Multidrug- and Rifampicin-Resistant Tuberculosis. Clin Infect Dis 2024; 78:1043-1052. [PMID: 37962987 PMCID: PMC11006115 DOI: 10.1093/cid/ciad694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 10/27/2023] [Accepted: 11/10/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND There are scarce data on the clinical outcomes of persons retreated with new/companion anti-tuberculosis (TB) drugs for multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB). We sought to evaluate the efficacy and safety of bedaquiline and delamanid containing regimens among patients with and without prior exposure to the new/companion drugs (bedaquiline, delamanid, linezolid, clofazimine, and fluoroquinolones). METHODS We conducted a retrospective cohort study among patients with pulmonary MDR/RR-TB in Georgia who received bedaquiline and delamanid combination as a part of a salvage regimen from November 2017 to December 2020 in a programmatic setting. RESULTS Among 106 persons with a median age of 39.5 years, 44 (41.5%) were previously treated with new/companion TB drugs. Patients with prior exposure to new/companion drugs had higher rates of baseline resistance compared to those without exposure to new/companion TB drugs (bedaquiline 15.2% vs 1.8%, linezolid 22.2% vs 16.7%). Sputum culture conversion rates among patients exposed and not exposed to new/companion drugs were 65.9% vs 98.0%, respectively (P < .001). Among patients with and without prior new/companion TB drug use, favorable outcome rates were 41.0% and 82.3%, respectively (P < .001). Treatment adherence in 32 (30.2%) patients was ≤80%. Five of 21 patients (23.8%) who had a baseline and repeat susceptibility test had acquired bedaquiline resistance. QTC/F prolongation (>500 ms) was rare (2.8%). CONCLUSIONS Prior exposure to new/companion TB drugs was associated with poor clinical outcomes and acquired drug resistance. Tailoring the TB regimen to each patient's drug susceptibility test results and burden of disease and enhancing adherence support may improve outcomes.
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Affiliation(s)
- L Mikiashvili
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - R R Kempker
- Department of Medicine, Division of Infectious Disease, Emory University School of Medicine, Atlanta, Georgia, USA
| | - T S Chakhaia
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - N Bablishvili
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Z Avaliani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - N Lomtadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
- Department of Medicine, David Tvildiani Medical University, Tbilisi, Georgia
- Department of Medicine, The University of Georgia, Tbilisi, Georgia
| | - M C Schechter
- Department of Medicine, Division of Infectious Disease, Emory University School of Medicine, Atlanta, Georgia, USA
| | - M Kipiani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
- Department of Medicine, David Tvildiani Medical University, Tbilisi, Georgia
- Department of Medicine, The University of Georgia, Tbilisi, Georgia
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6
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Ahmed SH, Haider H, Moeed A, Mahmood A, Shivani N, Shuja SH, Hayat J, Jamil B, Fatima R. Efficacy and safety of bedaquiline and delamanid in the treatment of drug-resistant tuberculosis in adults: A systematic review and meta-analysis. Indian J Tuberc 2024; 71:79-88. [PMID: 38296395 DOI: 10.1016/j.ijtb.2023.05.005] [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: 01/31/2023] [Revised: 04/21/2023] [Accepted: 05/10/2023] [Indexed: 02/15/2024]
Abstract
Multi and extensively drug-resistant tuberculosis is a grave cause of global public health concern due to its high mortality and limited treatment options. We conducted this systemic review and meta-analysis to evaluate the efficacy and safety of bedaquiline and delamanid, which have been added to the WHO-recommended regimen for treating drug-resistant tuberculosis. Electronic databases were searched from their inception until December 1st, 2021, for eligible studies assessing the efficacy and safety of bedaquiline and delamanid for treating drug-resistant tuberculosis. Binary outcomes were pooled using a DerSimonian-Laird random-effects model and arcsine transformation and reported on a log scale with a 95% confidence interval (CIs). Twenty-one studies were shortlisted in which bedaquiline, delamanid, and a combination of both were administered in 2477, 937, and 169 patients. Pooled culture conversion at 6 months was 0.801 (p < 0.001), 0.849 (p = 0.059) for bedaquiline and delamanid, respectively, and 0.823 (p = 0.017), concomitantly. In the bedaquiline cohort, the pooled proportion of all-cause mortality at 6 months was reported as 0.074 (p < 0.001), 0.031 (p = 0.372) in the delamanid cohort, and 0.172 in the combined cohort. The incidence of adverse events in the bedaquiline cohort ranged from 11.1% to 95.2%, from 13.2% to 86.2% in the delamanid cohort, and 92.5% in a study in the combined cohort. The incidence of QTC prolongation reported in each cohort is as follows: bedaquiline 0.163 (p < 0.001), delamanid 0.344 (p = 0.272) and combined 0.340 (p < 0.001). Our review establishes the efficacy of delamanid, bedaquiline, and their combined use in treating drug-resistant tuberculosis with reasonable rates of culture conversion, low mortality rates, and safety of co-administration, as seen with their effect on the QTc interval.
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Affiliation(s)
- Syeda Hoorulain Ahmed
- Department of Internal Medicine, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi, 74200, Pakistan.
| | - Hoorain Haider
- Department of Internal Medicine, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi, 74200, Pakistan
| | - Abdul Moeed
- Department of Internal Medicine, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi, 74200, Pakistan
| | - Aysal Mahmood
- Department of Internal Medicine, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi, 74200, Pakistan
| | - Nasir Shivani
- Department of Medicine, Bedford Hospital, Bedford, Bedfordshire, United Kingdom
| | - Syed Hasan Shuja
- Department of Internal Medicine, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi, 74200, Pakistan
| | - Javeria Hayat
- Department of Internal Medicine, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi, 74200, Pakistan
| | - Bushra Jamil
- Department of Medicine, Aga Khan University, National Stadium Road, Karachi, 74800, Pakistan
| | - Razia Fatima
- Common Management Unit (TB, HIV/AIDS & Malaria), Islamabad, Pakistan
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7
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Starshinova A, Nazarenko M, Belyaeva E, Chuzhov A, Osipov N, Kudlay D. Assessment of Comorbidity in Patients with Drug-Resistant Tuberculosis. Pathogens 2023; 12:1394. [PMID: 38133279 PMCID: PMC10747225 DOI: 10.3390/pathogens12121394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/12/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
A wide range of comorbidities, especially in multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) patients, markedly complicates selecting effective treatment of tuberculosis (TB) and preventing the development of adverse events. At present, it is impossible to assess the severity of comorbid pathologies and develop indications for the administration of accompanying therapy in TB patients. The aim of this study was to identify the difference in the range of comorbidities between patients with MDR-TB and XDR-TB and assess the impact of comorbidities on TB treatment. Materials and Methods: A retrospective, prospective study was conducted where 307 patients with MDR-TB and XDR-TB pulmonary tuberculosis aged 18 to 75 years who received eTB treatment from 2016 to 2021 in St. Petersburg hospitals were analyzed. The analysis showed that the comorbidity level in MDR-TB and XDR-TB patients with TB treatment success and treatment failure was comparable with the use of the Charlson Comorbidity Index (CCI). The CCI demonstrated declining data in terms of TB treatment outcome period in both groups. A slight predominance of CCI score (3 to 4 points) in XDR-TB (22.7%) vs. MDR-TB (15.4%) patients was found. In the case of an TB treatment failure, the CCI level in MDR-TB vs. XDR-TB patients was characterized by a significantly higher rate of low magnitude (ranging from 1 to 2 points) in 21.1% vs. 4.5% (p < 0.05), which was higher in XDR-TB patients (ranging from 4 to 5 points, in 10.0% vs. 0, χ2 = 33.7 (p < 0.01)). Chronic viral hepatitis B and C infection, cardiovascular pathology, chronic obstructive pulmonary disease, and chronic alcoholism were found to be significant comorbidity factors that influenced the TB treatment success. Conclusions: It is evident that XDR-TB patients comprise a cohort with the most severe disease course due to comorbidities impacting TB treatment efficacy. The obtained data pointed to the need to determine comorbidity severity in patients with drug-resistant Mbt prior to administering TB treatment schemes.
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Affiliation(s)
- Anna Starshinova
- Almazov National Medical Research Centre, 197341 Saint-Petersburg, Russia
| | - Michail Nazarenko
- Russia Pushkin TB Healthcare Dispensary, 196602 Pushkin, Russia;
- Scientific Research Institute of Phthisiopulmonology, 194064 Saint-Petersburg, Russia
| | | | - Alexander Chuzhov
- Interdistrict Petrograd-Primorsky TB Dispensary N. 3, 197343 Saint-Petersburg, Russia;
| | - Nikolay Osipov
- St. Petersburg State University, 199034 St. Petersburg, Russia;
- Steklov Mathematical Institute of Russian Academy of Sciences, 191023 Saint-Petersburg, Russia
| | - Dmitry Kudlay
- Immunology Department, I.M. Sechenov First Moscow State Medical University, 197022 Moscow, Russia;
- Institute of Immunology FMBA of Russia, 115478 Moscow, Russia
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8
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Robey JMS, Maity S, Aleshire SL, Ghosh A, Yadaw AK, Roy S, Mear SJ, Jamison TF, Sirasani G, Senanayake CH, Stringham RW, Gupton BF, Donsbach KO, Nelson RC, Shanahan CS. Application of Chiral Transfer Reagents to Improve Stereoselectivity and Yields in the Synthesis of the Antituberculosis Drug Bedaquiline. Org Process Res Dev 2023; 27:2146-2159. [PMID: 38025988 PMCID: PMC10661061 DOI: 10.1021/acs.oprd.3c00287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Indexed: 12/01/2023]
Abstract
Bedaquiline (BDQ) is an important drug for treating multidrug-resistant tuberculosis (MDR-TB), a worldwide disease that causes more than 1.6 million deaths yearly. The current synthetic strategy adopted by the manufacturers to assemble this molecule relies on a nucleophilic addition reaction of a quinoline fragment to a ketone, but it suffers from low conversion and no stereoselectivity, which subsequently increases the cost of manufacturing BDQ. The Medicines for All Institute (M4ALL) has developed a new reaction methodology to this process that not only allows high conversion of starting materials but also results in good diastereo- and enantioselectivity toward the desired BDQ stereoisomer. A variety of chiral lithium amides derived from amino acids were studied, and it was found that lithium (R)-2-(methoxymethyl)pyrrolidide, obtained from d-proline, results in high assay yield of the desired syn-diastereomer pair (82%) and with considerable stereocontrol (d.r. = 13.6:1, e.r. = 3.6:1, 56% ee), providing BDQ in up to a 64% assay yield before purification steps toward the final API. This represents a considerable improvement in the BDQ yield compared to previously reported conditions and could be critical to further lowering the cost of this life-saving drug.
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Affiliation(s)
- Juliana M. S. Robey
- Medicines
for All Institute, Virginia Commonwealth University, Richmond, Virginia 23284-3068, United
States
| | - Sanjay Maity
- Medicines
for All Institute, Virginia Commonwealth University, Richmond, Virginia 23284-3068, United
States
| | - Sarah L. Aleshire
- Medicines
for All Institute, Virginia Commonwealth University, Richmond, Virginia 23284-3068, United
States
| | - Angshuman Ghosh
- R&D
Centre, TCG Life Sciences Pvt. Limited, Kolkata, WB 700091, India
| | - Ajay K. Yadaw
- R&D
Centre, TCG Life Sciences Pvt. Limited, Kolkata, WB 700091, India
| | - Subho Roy
- R&D
Centre, TCG Life Sciences Pvt. Limited, Kolkata, WB 700091, India
| | - Sarah Jane Mear
- Department
of Chemistry, Massachusetts Institute of
Technology, Cambridge, Massachusetts 02139, United States
| | - Timothy F. Jamison
- Department
of Chemistry, Massachusetts Institute of
Technology, Cambridge, Massachusetts 02139, United States
| | - Gopal Sirasani
- TCG
GreenChem, Inc., Richmond, Virginia 23219, United States
| | | | - Rodger W. Stringham
- Medicines
for All Institute, Virginia Commonwealth University, Richmond, Virginia 23284-3068, United
States
| | - B. Frank Gupton
- Medicines
for All Institute, Virginia Commonwealth University, Richmond, Virginia 23284-3068, United
States
| | - Kai O. Donsbach
- Medicines
for All Institute, Virginia Commonwealth University, Richmond, Virginia 23284-3068, United
States
| | - Ryan C. Nelson
- Medicines
for All Institute, Virginia Commonwealth University, Richmond, Virginia 23284-3068, United
States
| | - Charles S. Shanahan
- Medicines
for All Institute, Virginia Commonwealth University, Richmond, Virginia 23284-3068, United
States
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9
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Ryckman T, Robsky K, Cilloni L, Zawedde-Muyanja S, Ananthakrishnan R, Kendall EA, Shrestha S, Turyahabwe S, Katamba A, Dowdy DW. Ending tuberculosis in a post-COVID-19 world: a person-centred, equity-oriented approach. THE LANCET. INFECTIOUS DISEASES 2023; 23:e59-e66. [PMID: 35963272 PMCID: PMC9365311 DOI: 10.1016/s1473-3099(22)00500-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 02/02/2023]
Abstract
The COVID-19 pandemic has disrupted systems of care for infectious diseases-including tuberculosis-and has exposed pervasive inequities that have long marred efforts to combat these diseases. The resulting health disparities often intersect at the individual and community levels in ways that heighten vulnerability to tuberculosis. Effective responses to tuberculosis (and other infectious diseases) must respond to these realities. Unfortunately, current tuberculosis programmes are generally not designed from the perspectives of affected individuals and fail to address structural determinants of health disparities. We describe a person-centred, equity-oriented response that would identify and focus on communities affected by disparities, tailor interventions to the mechanisms by which disparities worsen tuberculosis, and address upstream determinants of those disparities. We detail four key elements of the approach (data collection, programme design, implementation, and sustainability). We then illustrate how organisations at multiple levels might partner and adapt current practices to incorporate these elements. Such an approach could generate more substantial, sustainable, and equitable reductions in tuberculosis burden at the community level, highlighting the urgency of restructuring post-COVID-19 health systems in a more person-centred, equity-oriented way.
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Affiliation(s)
- Theresa Ryckman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Katherine Robsky
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - Lucia Cilloni
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stella Zawedde-Muyanja
- The Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Emily A Kendall
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda; Center for Tuberculosis Research, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sourya Shrestha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda; Clinical Epidemiology and Biostatistics Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda; Center for Tuberculosis Research, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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10
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Starshinova A, Dovgalyk I, Belyaeva E, Glushkova A, Osipov N, Kudlay D. Efficacy of Tuberculosis Treatment in Patients with Drug-Resistant Tuberculosis with the Use of Bedaquiline: The Experience of the Russian Federation. Antibiotics (Basel) 2022; 11:1622. [PMID: 36421267 PMCID: PMC9686766 DOI: 10.3390/antibiotics11111622] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 01/10/2024] Open
Abstract
UNLABELLED In the conditions of the continued growth of multiple- and extensive drug-resistant tuberculosis, use of the new highly effective anti-tuberculosis drugs in this patient category is of great relevance. The aim of the study was determination the efficacy of treatment in patients with multidrug- and extensive drug-resistant tuberculosis using bedaquiline based on studies published in the Russian Federation. MATERIALS AND METHODS The authors analyzed data published in studies from 2014 to 2022; 41 publications were included in total and 17 articles corresponded to the study design. The results of treatment of 1404 tuberculosis patients with MDR/XDR TB were described. Bedaquiline was used according to the standard scheme with a description of the treatment results after 24-26 weeks. Treatment efficacy was estimated according to accepted criteria. RESULTS OF THE STUDY The analysis showed that the treatment efficacy on conversion was achieved in 79.5% of cases (95% Cl 76.5-82.3), and recovery was observed in 82.0% of cases (95% Cl 78.6-85.1). Departure from the therapy was observed in rare cases (9.8%; 95% Cl 7.9-12.2). Deaths were recorded in 6.5% of cases (95% Cl 4.9-8.3), which were associated with the severe disease and concomitant pathology in 74.3%. The development of adverse events was noted in half of the patients (55.7%); however, bedaquiline cancellation occurred in a few cases (7.0%; 95% Cl 3.0-13.0). From analyzing data in patients with MDR and XDR TB, the efficacy of treatment was 89.9% (95% Cl 85.9-93.2) and 71.9% (95% Cl 66.2-77.1), respectively. CONCLUSION Use of bedaquiline in treatment makes it possible to achieve recovery of patients with MDR/XDR TB in 82.0% of cases with patients dropping out of treatment in 9.8%. At the same time, in patients with MDR TB, recovery was achieved in 89.9% of cases, while in patients with XDR TB, 71.9% of cases recovered.
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Affiliation(s)
- Anna Starshinova
- Almazov National Medical Research Centre, 197341 Saint-Petersburg, Russia
| | - Irina Dovgalyk
- St. Petersburg Research Institute of Phthisiopulmonology, 191036 Saint-Petersburg, Russia
| | | | - Anzhela Glushkova
- V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology, 192019 Saint-Petersburg, Russia
| | - Nikolay Osipov
- St. Petersburg Department of Steklov Mathematical Institute of Russian Academy of Sciences, 191023 Saint-Petersburg, Russia
- St. Petersburg State University, 199034 Saint-Petersburg, Russia
| | - Dmitry Kudlay
- Federal State Autonomous Educational Institution of Higher Education “First Moscow State Medical University Named after I.I. THEM. Sechenov” of the Ministry of Health of Russia (Sechenov University), St. Trubetskaya 8, Building 2, 119048 Moscow, Russia
- SSC Immunology Institute, 115552 Moscow, Russia
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11
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Nasiri MJ, Zangiabadian M, Arabpour E, Amini S, Khalili F, Centis R, D'Ambrosio L, Denholm JT, Schaaf HS, van den Boom M, Kurhasani X, Dalcolmo MP, Al-Abri S, Chakaya J, Alffenaar JW, Akkerman O, Silva DR, Muňoz-Torrico M, Seaworth B, Pontali E, Saderi L, Tiberi S, Zumla A, Migliori GB, Sotgiu G. Delamanid-containing regimens and multidrug-resistant tuberculosis: A systematic review and meta-analysis. Int J Infect Dis 2022; 124 Suppl 1:S90-S103. [PMID: 35245659 PMCID: PMC9731904 DOI: 10.1016/j.ijid.2022.02.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/20/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Multidrug-resistant tuberculosis (MDR-TB) is a life-threatening condition needing long poly-chemotherapy regimens. As no systematic reviews/meta-analysis is available to comprehensively evaluate the role of delamanid (DLM), we evaluated its effectiveness and safety. METHODS We reviewed the relevant scientific literature published up to January 20, 2022. The pooled success treatment rate with 95% confidence intervals (CI) was assessed using a random-effect model. We assessed studies for quality and bias, and considered P<0.05 to be statistically significant. RESULTS After reviewing 626 records, we identified 25 studies that met the inclusion criteria, 22 observational and 3 experimental, with 1276 and 411 patients, respectively. In observational studies the overall pooled treatment success rate of DLM-containing regimens was 80.9% (95% CI 72.6-87.2) with no evidence of publication bias (Begg's test; P >0.05). The overall pooled treatment success rate in DLM and bedaquiline-containing regimens was 75.2% (95% CI 68.1-81.1) with no evidence of publication bias (Begg's test; P >0.05). In experimental studies the pooled treatment success rate of DLM-containing regimens was 72.5 (95% CI 44.2-89.8, P <0.001, I2: 95.1%) with no evidence of publication bias (Begg's test; P >0.05). CONCLUSIONS In MDR-TB patients receiving DLM, culture conversion and treatment success rates were high despite extensive resistance with limited adverse events.
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Affiliation(s)
- Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Moein Zangiabadian
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Erfan Arabpour
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sirus Amini
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farima Khalili
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rosella Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | | | - Justin T. Denholm
- Victorian Tuberculosis Program, Melbourne Health, Victoria, Australia,Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia
| | - H. Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Martin van den Boom
- World Health Organization Regional Office for the Eastern Mediterranean Region, Cairo, Egypt
| | | | | | - Seif Al-Abri
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Jeremiah Chakaya
- Department of Medicine, dermatology and therapeutics, Kenyatta University, Nairobi, Kenya,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jan-Willem Alffenaar
- Sydney Institute of Infectious Diseases, University of Sydney, Sydney, NSW, Australia,School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia,Westmead Hospital, Sydney, NSW, Australia
| | - Onno Akkerman
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, Groningen, the Netherlands,University of Groningen, University Medical Center Groningen, Tuberculosis center Beatrixoord, Haren, the Netherlands
| | - Denise Rossato Silva
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Marcela Muňoz-Torrico
- Tuberculosis clinic, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Barbara Seaworth
- Department of Medicine University of Texas Health Science Center, Tyler, Texas
| | - Emanuele Pontali
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | - Laura Saderi
- Unità di Epidemiologia Clinica e Statistica Medica, Dipartimento di Scienze Mediche Chirurgiche e Sperimentali, Università degli Studi di Sassari, Sassari, Italia
| | - Simon Tiberi
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Alimuddin Zumla
- Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London, United Kingdom,National Institute for Health Research Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, United Kingdom
| | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy,Address for correspondence: Giovanni Battista Migliori, Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Via Roncaccio 16, Tradate, Varese, 21049, Italy.
| | - Giovanni Sotgiu
- Unità di Epidemiologia Clinica e Statistica Medica, Dipartimento di Scienze Mediche Chirurgiche e Sperimentali, Università degli Studi di Sassari, Sassari, Italia
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12
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Hatami H, Sotgiu G, Bostanghadiri N, Abadi SSD, Mesgarpour B, Goudarzi H, Migliori GB, Nasiri MJ. Bedaquiline-containing regimens and multidrug-resistant tuberculosis: a systematic review and meta-analysis. J Bras Pneumol 2022; 48:e20210384. [PMID: 35649043 PMCID: PMC8836629 DOI: 10.36416/1806-3756/e20210384] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/30/2021] [Indexed: 12/01/2022] Open
Abstract
Objective: Multidrug-resistant tuberculosis (MDR-TB) is a life-threatening infectious disease. Treatment requires multiple antimicrobial agents used for extended periods of time. The present study sought to evaluate the treatment success rate of bedaquiline-based regimens in MDR-TB patients. Methods: This was a systematic review and meta-analysis of studies published up to March 15, 2021. The pooled treatment success rates and 95% CIs were assessed with the fixed-effect model or the random-effects model. Values of p < 0.05 were considered significant for publication bias. Results: A total of 2,679 articles were retrieved by database searching. Of those, 29 met the inclusion criteria. Of those, 25 were observational studies (including a total of 3,536 patients) and 4 were experimental studies (including a total of 440 patients). The pooled treatment success rate was 74.7% (95% CI, 69.8-79.0) in the observational studies and 86.1% (95% CI, 76.8-92.1; p = 0.00; I2 = 75%) in the experimental studies. There was no evidence of publication bias (p > 0.05). Conclusions: In patients with MDR-TB receiving bedaquiline, culture conversion and treatment success rates are high even in cases of extensive resistance.
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Affiliation(s)
- Hossein Hatami
- . Department of Public Health, School of Public Health and Safety; Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Giovanni Sotgiu
- . Unità di Epidemiologia Clinica e Statistica Medica, Dipartimento di Scienze Mediche Chirurgiche e Sperimentali, Università degli Studi di Sassari, Sassari, Italia
| | - Narjess Bostanghadiri
- . Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sahel Shafiee Dolat Abadi
- . Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bita Mesgarpour
- . Department of Public and International Affairs, National Institute for Medical Research Development - NIMAD - Tehran, Iran
| | - Hossein Goudarzi
- . Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Javad Nasiri
- . Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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13
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Das M, Dalal A, Laxmeshwar C, Ravi S, Mamnoon F, Meneguim AC, Paryani R, Mathur T, Singh P, Mansoor H, Kalon S, Hossain FN, Lachenal N, Coutisson S, Ferlazzo G, Isaakidis P. One Step Forward: Successful End-of-Treatment Outcomes of Patients With Drug-Resistant Tuberculosis Who Received Concomitant Bedaquiline and Delamanid in Mumbai, India. Clin Infect Dis 2021; 73:e3496-e3504. [PMID: 33079176 DOI: 10.1093/cid/ciaa1577] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/14/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Médecins Sans Frontières Clinic in Mumbai, India, has been providing concomitant bedaquiline (BDQ) and delamanid (DLM) in treatment regimen for patients with drug-resistant tuberculosis (DR-TB) and limited therapeutic options, referred from other healthcare institutions, since 2016. The study documents the end-of-treatment outcomes, culture-conversion rates, and serious adverse events (SAEs) during treatment. METHODS This was a retrospective cohort study based on routinely collected program data. In clinic, treatment regimens are designed based on culture drug sensitivity test patterns and previous drug exposures, and are provided for 20-22 months. BDQ and DLM are extended beyond 24 weeks as off-label use. Patients who initiated DR-TB treatment including BDQ and DLM (concomitantly for at least 4 weeks) during February 2016-February 2018 were included. RESULTS Of the 70 patients included, the median age was 25 (interquartile range [IQR], 22-32) years and 56% were females. All except 1 were fluoroquinolone resistant. The median duration of exposure to BDQ and DLM was 77 (IQR, 43-96) weeks. Thirty-nine episodes of SAEs were reported among 30 (43%) patients, including 5 instances of QTc prolongation, assessed as possibly related to BDQ and/or DLM. The majority (69%) had culture conversion before 24 weeks of treatment. In 61 (87%), use of BDQ and DLM was extended beyond 24 weeks. Successful end-of-treatment outcomes were reported in 49 (70%) patients. CONCLUSIONS The successful treatment outcomes of this cohort show that regimens including concomitant BDQ and DLM for longer than 24 weeks are effective and can be safely administered on an ambulatory basis. National TB programs globally should scale up access to life-saving DR-TB regimens with new drugs.
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Affiliation(s)
| | - Alpa Dalal
- Jupiter Hospital, Thane, Maharashtra, India
| | | | | | | | | | | | | | | | | | | | | | - Nathalie Lachenal
- Pharmacovigilance Unit, Médecins Sans Frontières, Geneva, Switzerland
| | - Sylvine Coutisson
- Pharmacovigilance Unit, Médecins Sans Frontières, Geneva, Switzerland
| | - Gabriella Ferlazzo
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | - Petros Isaakidis
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
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14
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Khoshnood S, Taki E, Sadeghifard N, Kaviar VH, Haddadi MH, Farshadzadeh Z, Kouhsari E, Goudarzi M, Heidary M. Mechanism of Action, Resistance, Synergism, and Clinical Implications of Delamanid Against Multidrug-Resistant Mycobacterium tuberculosis. Front Microbiol 2021; 12:717045. [PMID: 34690963 PMCID: PMC8529252 DOI: 10.3389/fmicb.2021.717045] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/02/2021] [Indexed: 11/21/2022] Open
Abstract
Multidrug-resistant (MDR) isolates of Mycobacterium tuberculosis (MTB) remain a primary global threat to the end of tuberculosis (TB) era. Delamanid (DLM) is a nitro-dihydro-imidazooxazole derivative utilized to treat MDR-TB. DLM has distinct mechanism of action, inhibiting methoxy- and keto-mycolic acid (MA) synthesis through the F420 coenzyme mycobacteria system and generating nitrous oxide. While DLM resistance among MTB strains is uncommon, there are increasing reports in Asia and Europe, and such resistance will prolong the treatment courses of patients infected with MDR-TB. In this review, we address the antimycobacterial properties of DLM, report the global prevalence of DLM resistance, discuss the synergism of DLM with other anti-TB drugs, and evaluate the documented clinical trials to provide new insights into the clinical use of this antibiotic.
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Affiliation(s)
- Saeed Khoshnood
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Elahe Taki
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nourkhoda Sadeghifard
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Vahab Hassan Kaviar
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | | | - Zahra Farshadzadeh
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ebrahim Kouhsari
- Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mehdi Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Heidary
- Department of Laboratory Sciences, School of Paramedical Sciences, Sabzevar University of Medical Sciences, Sabzevar, Iran
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
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15
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Dooley KE, Rosenkranz SL, Conradie F, Moran L, Hafner R, von Groote-Bidlingmaier F, Lama JR, Shenje J, De Los Rios J, Comins K, Morganroth J, Diacon AH, Cramer YS, Donahue K, Maartens G. QT effects of bedaquiline, delamanid, or both in patients with rifampicin-resistant tuberculosis: a phase 2, open-label, randomised, controlled trial. THE LANCET. INFECTIOUS DISEASES 2021; 21:975-983. [PMID: 33587897 PMCID: PMC8312310 DOI: 10.1016/s1473-3099(20)30770-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/13/2020] [Accepted: 09/14/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Bedaquiline and delamanid are the first drugs of new classes registered for tuberculosis treatment in 40 years. Each can prolong the QTc interval, with maximum effects occurring weeks after drug initiation. The cardiac safety and microbiological activity of these drugs when co-administered are not well-established. Our aim was to characterise the effects of bedaquiline, delamanid, or both on the QTc interval, longitudinally over 6 months of multidrug treatment, among patients with multidrug-resistant or rifampicin-resistant tuberculosis taking multidrug background therapy. METHODS ACTG A5343 is a phase 2, open-label, randomised, controlled trial in which adults with multidrug-resistant or rifampicin-resistant tuberculosis receiving multidrug background treatment were randomly assigned 1:1:1 by centrally, computer-generated randomisation, by means of permuted blocks to receive bedaquiline, delamanid, or both for 24 weeks. Participants were enrolled at TASK in Cape Town and the South African Tuberculosis Vaccine Initiative in Worcester, both in South Africa, and Hospital Maria Auxiliadora in Peru. Individuals with QTc greater than 450 ms were excluded. HIV-positive participants received dolutegravir-based antiretroviral therapy. Clofazimine was disallowed, and levofloxacin replaced moxifloxacin. ECG in triplicate and sputum cultures were done fortnightly. The primary endpoint was mean QTcF change from baseline (averaged over weeks 8-24); cumulative culture conversation at week 8-24 was an exploratory endpoint. Analyses included all participants who initiated study tuberculosis treatment (modified intention-to-treat population). This trial is registered with ClinicalTrials.gov, NCT02583048 and is ongoing. FINDINGS Between Aug 26, 2016 and July 13, 2018, of 174 screened, 84 participants (28 in each treatment group, and 31 in total with HIV) were enrolled. Two participants did not initiate study treatment (one in the delamanid group withdrew consent and one in the bedaquiline plus delamanid group) did not meet the eligibility criterion). Mean change in QTc from baseline was 12·3 ms (95% CI 7·8-16·7; bedaquiline), 8·6 ms (4·0-13·1; delamanid), and 20·7 ms (16·1-25·3) (bedaquiline plus delamanid). There were no grade 3 or 4 adverse QTc prolongation events and no deaths during study treatment. Cumulative culture conversion by week 8 was 21 (88%) of 24 (95% CI 71-97; bedaquiline), 20 (83%) of 24 (65-95; delamanid), and 19 (95%) of 20 (79-100; bedaquiline plus delamanid) and was 92% (77-99) for bedaquiline, 91% (76-99), for delamanid, and 95% (79-100) for bedaquiline plus delamanid at 24 weeks. INTERPRETATION Combining bedaquiline and delamanid has a modest, no more than additive, effect on the QTc interval, and initial microbiology data are encouraging. This study provides supportive evidence for use of these agents together in patients with multidrug-resistant or rifampicin-resistant tuberculosis with normal baseline QTc values. FUNDING Division of AIDS, National Institutes of Health.
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Affiliation(s)
- Kelly E Dooley
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | | | | | - Laura Moran
- Social & Scientific Systems, Silver Spring, MD, USA
| | - Richard Hafner
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | | | - Javier R Lama
- Asociación Civil Impacta Salud y Educacion, Lima, Peru
| | - Justin Shenje
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Cape Town, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Kyla Comins
- TASK Applied Science, Cape Town, South Africa
| | | | - Andreas H Diacon
- TASK Applied Science, Cape Town, South Africa; Stellenbosch University, Cape Town, South Africa
| | | | - Kathleen Donahue
- Frontier Science and Technology Research Foundation, Amherst, NY, USA
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, Cape Town, South Africa
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16
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Riskiyev A, Ciobanu A, Hovhannesyan A, Akopyan K, Gadoev J, Parpieva N. Characteristics and Treatment Outcomes of Patients with Tuberculosis Receiving Adjunctive Surgery in Uzbekistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126541. [PMID: 34204519 PMCID: PMC8296362 DOI: 10.3390/ijerph18126541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/11/2021] [Accepted: 05/18/2021] [Indexed: 11/19/2022]
Abstract
Surgical interventions are performed as an adjunct to pharmacological treatment in Uzbekistan in 10–12% of diagnosed tuberculosis (TB) patients. In this study among patients with respiratory TB who had surgical interventions in Republican Specialized Scientific-Practical Medical Centre of Phthisiology and Pulmonology of Uzbekistan (RSSPMCPP) from January to May 2017, we describe (i) reasons and types of surgical intervention, (ii) post-surgical complications, (iii) histological diagnosis before and after surgery, and (iv) treatment outcomes. There were 101 patients included in the analysis (mean age 36 years; 51% male; 71% lived in rural areas). The main indications for surgical intervention included pulmonary tuberculoma (40%), fibrocavitary, or cavernous pulmonary TB (23%) and massive hemoptysis (20%). Pulmonary resections were the most frequent surgical procedures: segmentectomy (41%), lobectomy or bilobectomy (19%), and combined resection (17%). Ten patients (9%) suffered post-surgery complications. According to histological examination after surgery, TB was confirmed in 81 (80%) patients. For the other 20 patients, the confirmed diagnoses were: lung cancer (n = 6), echinococcosis (n = 5), post-TB fibrosis (n = 5), non-tuberculous pleurisy (n = 2), hamartoma (n = 1), and pneumonia (n = 1). The majority of patients (94%), who underwent surgery, were considered successfully treated. In conclusion, adjunctive surgical therapy can be an option for TB treatment, especially in cases of complicated TB.
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Affiliation(s)
- Anvar Riskiyev
- Republican Specialized Scientific-Practical Medical Centre of Phthisiology and Pulmonology, 1 Alimov Street, Tashkent City 100086, Uzbekistan;
- Correspondence: ; Tel.: +998-97-710-6070
| | - Ana Ciobanu
- World Health Organization Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen, Denmark; (A.C.); (A.H.); (K.A.)
| | - Arax Hovhannesyan
- World Health Organization Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen, Denmark; (A.C.); (A.H.); (K.A.)
| | - Kristina Akopyan
- World Health Organization Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen, Denmark; (A.C.); (A.H.); (K.A.)
- Tuberculosis Research and Prevention Centre NGO, Yerevan 0070, Armenia
| | - Jamshid Gadoev
- World Health Organization Country Office in Uzbekistan, 16 Tarobiy Street, Tashkent City 100100, Uzbekistan;
| | - Nargiza Parpieva
- Republican Specialized Scientific-Practical Medical Centre of Phthisiology and Pulmonology, 1 Alimov Street, Tashkent City 100086, Uzbekistan;
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17
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Sotgiu G, Rosales-Klintz S, Centis R, D'Ambrosio L, Verduin R, Correia AM, Cirule A, Duarte R, Gadzheva B, Gualano G, Kunst H, Palmieri F, Riekstina V, Stefanova D, Tiberi S, van der Werf MJ, Migliori GB. TB management in the European Union/European Economic Area: a multi-centre survey. Int J Tuberc Lung Dis 2021; 25:126-133. [PMID: 33656424 PMCID: PMC7849393 DOI: 10.5588/ijtld.20.0849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Essential TB care in the European Union/European Economic Area (EU/EEA) comprises 21 standards for the diagnosis, treatment and prevention of TB that constitute the European Union Standards for Tuberculosis Care (ESTC). METHODS: In 2017, we conducted an audit on TB management and infection control measures against the ESTC standards. TB reference centres in five EU/EEA countries were purposely selected to represent the heterogeneous European TB burden and examine geographic variability. RESULTS: Data from 122 patients, diagnosed between 2012 and 2015 with multidrug-resistant TB (n = 49), extensively drug-resistant TB (XDR-TB) (n = 11), pre-XDR-TB (n = 29) and drug-susceptible TB (n = 33), showed that TB diagnosis and treatment practices were in general in agreement with the ESTC. CONCLUSION: Overall, TB management and infection control practices were in agreement with the ESTC in the selected EU/EEA reference centres. Areas for improvement include strengthening of integrated care services and further implementation of patient-centred approaches.
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Affiliation(s)
- G Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - S Rosales-Klintz
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - R Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Tradate, Italy
| | - L D'Ambrosio
- Public Health Consulting Group, Lugano, Switzerland
| | - R Verduin
- Verduin Public Health Consult, Oegstgeest, the Netherlands
| | - A M Correia
- Regional Health Administration of the North, Department of Public Health, Porto, Portugal
| | - A Cirule
- Centre of TB and Lung Diseases, Riga East University Hospital, Riga, Latvia
| | - 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
| | - B Gadzheva
- The Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM) Programme, Department of Management of Specialized Donor-Funded Programmes, Ministry of Health, Sofia, Bulgaria
| | - G Gualano
- Respiratory Infectious Diseases Unit, L Spallanzani National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - H Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - F Palmieri
- Respiratory Infectious Diseases Unit, L Spallanzani National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - V Riekstina
- Centre of TB and Lung Diseases, Riga East University Hospital, Riga, Latvia
| | - D Stefanova
- St Sofia University Hospital for Active Treatment of Respiratory Diseases, Sofia, Bulgaria
| | - S Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK, Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M J van der Werf
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - G B Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Tradate, Italy
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18
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Nguyen TVA, Anthony RM, Cao TTH, Bañuls AL, Nguyen VAT, Vu DH, Nguyen NV, Alffenaar JWC. Delamanid Resistance: Update and Clinical Management. Clin Infect Dis 2021; 71:3252-3259. [PMID: 32521000 DOI: 10.1093/cid/ciaa755] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/05/2020] [Indexed: 12/29/2022] Open
Abstract
Delamanid, a-first-in-class bicyclic nitroimidazole, was recently approved for multidrug-resistant tuberculosis treatment. Pitted against the hope for improving treatment outcomes is the threat of the rapid resistance emergence. This review provides information on the mechanisms of action, resistance emergence, and drug susceptibility testing (DST) for delamanid. Delamanid resistance has already been reported in both in vitro experiments and clinical settings. Although mutations conferring delamanid resistance have been identified in fbiA, fbiB, fbiC, ddn, and fgd1 genes of Mycobacterium tuberculosis, knowledge about the molecular resistance mechanisms is limited, and there remains no standardized DST method. The rapid acquisition of delamanid resistance emphasizes the need for optimal use of new drugs, the need for drug resistance surveillance, and a comprehensive understanding of drug resistance mechanisms. Further studies are necessary to investigate genetic and phenotypic changes that determine clinically relevant delamanid resistance to help develop a rapid delamanid DST.
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Affiliation(s)
- Thi Van Anh Nguyen
- Department of Life Sciences, University of Science and Technology of Hanoi (USTH), Vietnam Academy of Science and Technology (VAST), Hanoi, Vietnam.,LMI Drug Resistance in South East Asia, Hanoi, Vietnam
| | - Richard M Anthony
- Tuberculosis reference laboratory, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Thi Thu Huyen Cao
- The National Centre of Drug information and Adverse Drug Reaction Monitoring, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Anne-Laure Bañuls
- LMI Drug Resistance in South East Asia, Hanoi, Vietnam.,MIVEGEC, University of Montpellier-IRD-CNRS, Montpellier, France
| | - Van Anh Thi Nguyen
- Laboratory of Tuberculosis, Department of Bacteriology, National Institute of Hygiene and Epidemiology of Vietnam, Hanoi, Vietnam
| | - Dinh Hoa Vu
- The National Centre of Drug information and Adverse Drug Reaction Monitoring, Hanoi University of Pharmacy, Hanoi, Vietnam
| | | | - Jan-Willem C Alffenaar
- University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, Australia.,Westmead hospital, Sydney, Australia.,Marie Bashir Institute of Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
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19
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Bedaquiline: Current status and future perspectives. J Glob Antimicrob Resist 2021; 25:48-59. [PMID: 33684606 DOI: 10.1016/j.jgar.2021.02.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/28/2021] [Accepted: 02/17/2021] [Indexed: 12/21/2022] Open
Abstract
The development of drug-resistant tuberculosis (TB) is a major threat worldwide. Based on World Health Organization (WHO) reports, it is estimated that more than 500 000 new cases of drug-resistant TB occur annually. In addition, there are alarming reports of increasing multidrug-resistant TB (MDR-TB) and the emergence of extensively drug-resistant TB (XDR-TB) from different countries of the world. Therefore, new options for TB therapy are required. Bedaquiline (BDQ), a novel anti-TB drug, has significant minimum inhibitory concentrations (MICs) both against drug-susceptible and drug-resistant TB. Moreover, BDQ was recently approved for therapy of MDR-TB. The current narrative review summarises the available data on BDQ resistance, describes its antimicrobial properties, and provides new perspectives on clinical use of this novel anti-TB agent.
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20
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Kwon YS, Jeon D, Kang H, Yim JJ, Shim TS. Concurrent use of bedaquiline and delamanid for the treatment of fluoroquinolone-resistant multidrug-resistant tuberculosis: a nationwide cohort study in South Korea. Eur Respir J 2021; 57:13993003.03026-2020. [PMID: 33093123 DOI: 10.1183/13993003.03026-2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/11/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Yong-Soo Kwon
- Dept of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Doosoo Jeon
- Dept of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Hyungseok Kang
- Dept of Chest Medicine, Masan National Tuberculosis Hospital, Masan, South Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Tae Sun Shim
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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21
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Martín-García M, Esteban J. Evaluating bedaquiline as a treatment option for multidrug-resistant tuberculosis. Expert Opin Pharmacother 2021; 22:535-541. [PMID: 33393406 DOI: 10.1080/14656566.2020.1867538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Despite efforts to the contrary, tuberculosis remains one of the leading causes of death in the world. The appearance of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains of Mycobacterium tuberculosis has increased the need for new therapeutic options against these strains.Areas covered: This review covers the in vitro susceptibility, pharmacokinetics, and pharmacodynamics of bedaquiline, a new drug shown to be active against M. tuberculosis-resistant strains. The authors further review clinical data concerning its use against MDR and XDR strains, discussing recent clinical guidelines from different international societies.Expert opinion: Available data demonstrate the usefulness of bedaquiline against resistant M. tuberculosis. Despite the difficulty in analyzing multidrug therapies, the use of bedaquiline in MDR and XDR tuberculosis increases success rates, allowing shortened treatments and lower drug use than previously recommended regimens. Moreover, the fact that MDR and XDR strains are common in many places creates a need to include this drug in the currently available protocols. It is essential to overcome the substantial barriers that some countries encounter in obtaining bedaquiline, as doing so will make therapeutic regimens including this drug available for all patients.
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Affiliation(s)
- Marta Martín-García
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
| | - Jaime Esteban
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
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22
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Häcker B, Schönfeld N, Krieger D, Otto-Knapp R, Hittel N, Pflugmacher P, Bauer T. Long-term safety and tolerability of delamanid-containing regimens in MDR- and XDR-TB patients in a specialised tuberculosis treatment center in Berlin, Germany. Eur Respir J 2020; 56:2000009. [PMID: 32631834 DOI: 10.1183/13993003.00009-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/04/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Brit Häcker
- Klinik für Pneumologie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
- DZK - German Central Committee against tuberculosis (DZK e.V.), Berlin, Germany
| | - Nicolas Schönfeld
- Klinik für Pneumologie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
- DZK - German Central Committee against tuberculosis (DZK e.V.), Berlin, Germany
| | - David Krieger
- Klinik für Pneumologie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Ralf Otto-Knapp
- DZK - German Central Committee against tuberculosis (DZK e.V.), Berlin, Germany
- MVZ PneumoCare, Berlin, Germany
| | | | - Patricia Pflugmacher
- Klinik für Pneumologie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Torsten Bauer
- Klinik für Pneumologie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
- DZK - German Central Committee against tuberculosis (DZK e.V.), Berlin, Germany
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23
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Lee HH, Jo KW, Yim JJ, Jeon D, Kang H, Shim TS. Interim treatment outcomes in multidrug-resistant tuberculosis patients treated sequentially with bedaquiline and delamanid. Int J Infect Dis 2020; 98:478-485. [PMID: 32640367 DOI: 10.1016/j.ijid.2020.07.001] [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: 06/08/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The objective of this study was to evaluate the efficacy and safety of the sequential use of bedaquiline (Bdq) and delamanid (Dlm) in patients with multidrug-resistant tuberculosis (MDR-TB) and limited treatment options. METHODS This study evaluated 74 MDR-TB patients treated between March 2016 and December 2018 with Bdq followed by Dlm (n = 22), or vice versa (n= 52), combined with optimized background regimens. RESULTS The mean age of the participants was 49.0 ± 15.8 years. Fifty-one (68.9%) of the participants were male. Fluoroquinolone resistance was identified in 54 (72.9%) patients, including 20 (27.0%) with extensively drug-resistant TB. Of the 47 (63.5%) patients with positive cultures at the commencement of the first new drug, culture conversion occurred in 44 (93.6%). The interim treatment outcome after 12 months was favourable in 68/74 patients (91.9%). Twenty-four weeks of treatment were completed in 137 of 148 episodes of new drug use (92.3%). Regarding the 11 early discontinuation events, six patients stopped using a new drug due to adverse drug reactions that were not life-threatening, including one (1.4%) who stopped Bdq due to QT-prolongation. CONCLUSIONS Sequential use of the two new drugs appears to be an effective and safe option for MDR-TB patients with few treatment options.
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Affiliation(s)
- Hoon Hee Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Kyung-Wook Jo
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Doosoo Jeon
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea
| | - Hyungseok Kang
- Department of Chest Medicine, Masan National Tuberculosis Hospital, Changwon, South Korea
| | - Tae Sun Shim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
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24
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Pecho-Silva S, Navarro-Solsol AC. First case report in Latin America: Oral treatment of multidrug-resistant tuberculosis with delamanid and bedaquiline in combination with linezolid, moxifloxacin and clofazimine following a DRESS syndrome in a peruvian patient. Pulmonology 2020; 27:77-79. [PMID: 32444311 DOI: 10.1016/j.pulmoe.2020.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- S Pecho-Silva
- Universidad Cientifica del Sur Facultad de Ciencias de la Salud, Peru.
| | - A C Navarro-Solsol
- Universidad Nacional de Ucayali, Universidad Nacional de Ucayali Facultad de Medicina Humana, Peru
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25
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Post-Tuberculosis (TB) Treatment: The Role of Surgery and Rehabilitation. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10082734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Even though the majority of tuberculosis (TB) programmes consider their work completed when a patient is ‘successfully’ cured, patients often continue to suffer with post-treatment or surgical sequelae. This review focuses on describing the available evidence with regard to the diagnosis and management of post-treatment and surgical sequelae (pulmonary rehabilitation). We carried out a non-systematic literature review based on a PubMed search using specific key-words, including various combinations of ‘TB’, ‘MDR-TB’, ‘XDR-TB’, ‘surgery’, ‘functional evaluation’, ‘sequelae’ and ‘pulmonary rehabilitation’. References of the most important papers were retrieved to improve the search accuracy. We identified the main areas of interest to describe the topic as follows: 1) ‘Surgery’, described through observational studies and reviews, systematic reviews and meta-analyses, IPD (individual data meta-analyses), and official guidelines (GRADE (Grading of Recommendations Assessment, Development and Evaluation) or not GRADE-based); 2) Post-TB treatment functional evaluation; and 3) Pulmonary rehabilitation interventions. We also highlighted the priority areas for research for the three main areas of interest. The collection of high-quality standardized variables would allow advances in the understanding of the need for, and effectiveness of, pulmonary rehabilitation at both the individual and the programmatic level. The initial evidence supports the importance of the adequate functional evaluation of these patients, which is necessary to identify those who will benefit from pulmonary rehabilitation.
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26
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Model-Informed Drug Discovery and Development Strategy for the Rapid Development of Anti-Tuberculosis Drug Combinations. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10072376] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The increasing emergence of drug-resistant tuberculosis requires new effective and safe drug regimens. However, drug discovery and development are challenging, lengthy and costly. The framework of model-informed drug discovery and development (MID3) is proposed to be applied throughout the preclinical to clinical phases to provide an informative prediction of drug exposure and efficacy in humans in order to select novel anti-tuberculosis drug combinations. The MID3 includes pharmacokinetic-pharmacodynamic and quantitative systems pharmacology models, machine learning and artificial intelligence, which integrates all the available knowledge related to disease and the compounds. A translational in vitro-in vivo link throughout modeling and simulation is crucial to optimize the selection of regimens with the highest probability of receiving approval from regulatory authorities. In vitro-in vivo correlation (IVIVC) and physiologically-based pharmacokinetic modeling provide powerful tools to predict pharmacokinetic drug-drug interactions based on preclinical information. Mechanistic or semi-mechanistic pharmacokinetic-pharmacodynamic models have been successfully applied to predict the clinical exposure-response profile for anti-tuberculosis drugs using preclinical data. Potential pharmacodynamic drug-drug interactions can be predicted from in vitro data through IVIVC and pharmacokinetic-pharmacodynamic modeling accounting for translational factors. It is essential for academic and industrial drug developers to collaborate across disciplines to realize the huge potential of MID3.
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27
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Silva DR, Mello FCDQ, Migliori GB. Shortened tuberculosis treatment regimens: what is new? J Bras Pneumol 2020; 46:e20200009. [PMID: 32215450 PMCID: PMC7462706 DOI: 10.36416/1806-3756/e20200009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/30/2020] [Indexed: 11/17/2022] Open
Abstract
Given the global burden of tuberculosis, shortened treatment regimens with existing or repurposed drugs are needed to contribute to tuberculosis control. The long duration of treatment of drug-susceptible tuberculosis (DS-TB) is associated with nonadherence and loss to follow up, and the treatment success rate of multidrug-resistant tuberculosis (MDR-TB) is low (approximately 50%) with longer regimens. In this review article, we report recent advances and ongoing clinical trials aimed at shortening regimens for DS-TB and MDR-TB. We discuss the role of high-dose rifampin, as well as that of clofazimine and linezolid in regimens for DS-TB. There are at least 5 ongoing clinical trials and 17 observational studies and clinical trials evaluating shorter regimens for DS-TB and MDR-TB, respectively. We also report the results of observational studies and clinical trials evaluating a standardized nine-month moxifloxacin-based regimen for MDR-TB. Further studies, especially randomized clinical trials, are needed to evaluate regimens including newer drugs, drugs proven to be or highly likely to be efficacious, and all-oral drugs in an effort to eliminate the need for injectable drugs.
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Affiliation(s)
- Denise Rossato Silva
- . Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | | | - Giovanni Battista Migliori
- . Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italia
- . Blizard Institute, Queen Mary University of London, London, United Kingdom
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28
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Mondoni M, Centanni S, Sotgiu G. New perspectives on difficult-to-treat tuberculosis based on old therapeutic approaches. Int J Infect Dis 2020; 92S:S91-S99. [PMID: 32114204 DOI: 10.1016/j.ijid.2020.02.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 12/11/2022] Open
Abstract
Tuberculosis (TB) is an important clinical and public health issue worldwide. Despite improved treatment success rates following the introduction of antibiotics in daily clinical practice, the expected decline in incidence has been hampered by HIV epidemics and multi- and extensively drug-resistant TB. During the pre-antibiotic era, TB therapies were mainly based on improving hygiene conditions, strengthening the immune system, and targeting the rest of the affected lungs with invasive techniques. Detailed knowledge of old non-pharmacological therapies might support physicians and researchers in the identification of new solutions for difficult-to-treat patients. We performed a narrative literature review on the main old therapeutic options prescribed for patients with TB. The main recommendations and contraindications of sanatorium therapies (i.e., bed rest, fresh air, sunlight) and pulmonary collapse techniques are reviewed, evaluating their physiological basis and their impact on patient outcomes. We report studies describing new interventional pulmonary and surgical techniques and assess new perspectives based on old medical and surgical treatments, whose potential implementation could help complicated patients.
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Affiliation(s)
- Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.
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29
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Nathavitharana RR, Lederer P, Tierney DB, Nardell E. Treatment as prevention and other interventions to reduce transmission of multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2020; 23:396-404. [PMID: 31064617 DOI: 10.5588/ijtld.18.0276] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Drug-resistant tuberculosis (DR-TB) represents a major programmatic challenge at the national and global levels. Only ∼30% of patients with multidrug-resistant TB (MDR-TB) were diagnosed, and ∼25% were initiated on treatment for MDR-TB in 2016. Increasing evidence now points towards primary transmission of DR-TB, rather than inadequate treatment, as the main driver of the DR-TB epidemic. The cornerstone of DR-TB transmission prevention should be earlier diagnosis and prompt initiation of effective treatment for all patients with DR-TB. Despite the extensive scale-up of Xpert® MTB/RIF testing, major implementation barriers continue to limit its impact. Although there is longstanding evidence in support of the rapid impact of treatment on patient infectiousness, delays in the initiation of effective DR-TB treatment persist, resulting in ongoing transmission. However, it is also imperative to address the burden of latent drug-resistant tuberculous infection because it is estimated that many DR-TB patients will become infectious before seeking care and encounter various diagnostic delays before treatment. Addressing latent DR-TB primarily consists of identifying, treating and following the contacts of patients with MDR-TB, typically through household contact evaluation. Adjunctive measures, such as improved ventilation and use of germicidal ultraviolet technology can further reduce TB transmission in high-risk congregate settings. Although many gaps remain in our biological understanding of TB transmission, implementation barriers to early diagnosis and rapid initiation of effective DR-TB treatment can and must be overcome if we are to impact DR-TB incidence in the short and long term.
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Affiliation(s)
- R R Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - P Lederer
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - D B Tierney
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - E Nardell
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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30
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Olayanju O, Esmail A, Limberis J, Dheda K. A regimen containing bedaquiline and delamanid compared to bedaquiline in patients with drug-resistant tuberculosis. Eur Respir J 2020; 55:13993003.01181-2019. [PMID: 31619478 DOI: 10.1183/13993003.01181-2019] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 10/09/2019] [Indexed: 11/05/2022]
Abstract
There are limited data on combining delamanid and bedaquiline in drug-resistant tuberculosis (DR-TB) regimens. Prospective long-term outcome data, including in HIV-infected persons, are unavailable.We prospectively followed up 122 South African patients (52.5% HIV-infected) with DR-TB and poor prognostic features between 2014 and 2018. We examined outcomes and safety in those who received a bedaquiline-based regimen (n=82) compared to those who received a bedaquiline-delamanid combination regimen (n=40).There was no significant difference in 6-month culture conversion (92.5% versus 81.8%; p=0.26) and 18-month favourable outcome rate (63.4% versus 67.5%; p=0.66) in the bedaquiline versus the bedaquiline-delamanid combination group, despite the latter having more advanced drug resistance (3.7% versus 22.5% resistant to at least five drugs; p=0.001) and higher pre-treatment failure rates (12.2% versus 52.5% with pre-treatment multidrug-resistant TB therapy failure; p<0.001). Although the proportion of prolongation of the QT interval corrected using Fridericia's formula was higher in the combination group (>60 ms from baseline (p=0.001) or >450 ms during treatment (p=0.001)), there were no symptomatic cases or drug withdrawals in either group. Results were similar in HIV-infected patients.A bedaquiline-delamanid combination regimen showed comparable long-term safety compared to a bedaquiline-based regimen in patients with DR-TB, irrespective of HIV status. These data inform regimen selection in patients with DR-TB from TB-endemic settings.
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Affiliation(s)
- Olatunde Olayanju
- Centre for Lung Infection and Immunity, Division of Pulmonology, Dept of Medicine, and UCT Lung Institute and South African MRC/UCT Centre for the Study of Antimicrobial Resistance, Division of Pulmonology, University of Cape Town, Cape Town, South Africa.,Co-first author
| | - Aliasgar Esmail
- Centre for Lung Infection and Immunity, Division of Pulmonology, Dept of Medicine, and UCT Lung Institute and South African MRC/UCT Centre for the Study of Antimicrobial Resistance, Division of Pulmonology, University of Cape Town, Cape Town, South Africa.,Co-first author
| | - Jason Limberis
- Centre for Lung Infection and Immunity, Division of Pulmonology, Dept of Medicine, and UCT Lung Institute and South African MRC/UCT Centre for the Study of Antimicrobial Resistance, Division of Pulmonology, University of Cape Town, Cape Town, South Africa
| | - Keertan Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, Dept of Medicine, and UCT Lung Institute and South African MRC/UCT Centre for the Study of Antimicrobial Resistance, Division of Pulmonology, University of Cape Town, Cape Town, South Africa .,Faculty of Infectious and Tropical Diseases, Dept of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK
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Borisov S, Danila E, Maryandyshev A, Dalcolmo M, Miliauskas S, Kuksa L, Manga S, Skrahina A, Diktanas S, Codecasa LR, Aleksa A, Bruchfeld J, Koleva A, Piubello A, Udwadia ZF, Akkerman OW, Belilovski E, Bernal E, Boeree MJ, Cadiñanos Loidi J, Cai Q, Cebrian Gallardo JJ, Dara M, Davidavičienė E, Forsman LD, De Los Rios J, Denholm J, Drakšienė J, Duarte R, Elamin SE, Escobar Salinas N, Ferrarese M, Filippov A, Garcia A, García-García JM, Gaudiesiute I, Gavazova B, Gayoso R, Gomez Rosso R, Gruslys V, Gualano G, Hoefsloot W, Jonsson J, Khimova E, Kunst H, Laniado-Laborín R, Li Y, Magis-Escurra C, Manfrin V, Marchese V, Martínez Robles E, Matteelli A, Mazza-Stalder J, Moschos C, Muñoz-Torrico M, Mustafa Hamdan H, Nakčerienė B, Nicod L, Nieto Marcos M, Palmero DJ, Palmieri F, Papavasileiou A, Payen MC, Pontarelli A, Quirós S, Rendon A, Saderi L, Šmite A, Solovic I, Souleymane MB, Tadolini M, van den Boom M, Vescovo M, Viggiani P, Yedilbayev A, Zablockis R, Zhurkin D, Zignol M, Visca D, Spanevello A, Caminero JA, Alffenaar JW, Tiberi S, Centis R, D'Ambrosio L, Pontali E, Sotgiu G, Migliori GB. Surveillance of adverse events in the treatment of drug-resistant tuberculosis: first global report. Eur Respir J 2019; 54:13993003.01522-2019. [PMID: 31601711 DOI: 10.1183/13993003.01522-2019] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/17/2019] [Indexed: 11/05/2022]
Abstract
The World Health Organization (WHO) recommends that countries implement pharmacovigilance and collect information on active drug safety monitoring (aDSM) and management of adverse events.The aim of this prospective study was to evaluate the frequency and severity of adverse events to anti-tuberculosis (TB) drugs in a cohort of consecutive TB patients treated with new (i.e. bedaquiline, delamanid) and repurposed (i.e. clofazimine, linezolid) drugs, based on the WHO aDSM project. Adverse events were collected prospectively after attribution to a specific drug together with demographic, bacteriological, radiological and clinical information at diagnosis and during therapy. This interim analysis included patients who completed or were still on treatment at time of data collection.Globally, 45 centres from 26 countries/regions reported 658 patients (68.7% male, 4.4% HIV co-infected) treated as follows: 87.7% with bedaquiline, 18.4% with delamanid (6.1% with both), 81.5% with linezolid and 32.4% with clofazimine. Overall, 504 adverse event episodes were reported: 447 (88.7%) were classified as minor (grade 1-2) and 57 (11.3%) as serious (grade 3-5). The majority of the 57 serious adverse events reported by 55 patients (51 out of 57, 89.5%) ultimately resolved. Among patients reporting serious adverse events, some drugs held responsible were discontinued: bedaquiline in 0.35% (two out of 577), delamanid in 0.8% (one out of 121), linezolid in 1.9% (10 out of 536) and clofazimine in 1.4% (three out of 213) of patients. Serious adverse events were reported in 6.9% (nine out of 131) of patients treated with amikacin, 0.4% (one out of 221) with ethionamide/prothionamide, 2.8% (15 out of 536) with linezolid and 1.8% (eight out of 498) with cycloserine/terizidone.The aDSM study provided valuable information, but implementation needs scaling-up to support patient-centred care.
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Affiliation(s)
- Sergey Borisov
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation.,These authors contributed equally
| | - Edvardas Danila
- Clinic of Chest Diseases, Immunology and Allergology, Vilnius University Medical Faculty, Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | - Margareth Dalcolmo
- Reference Center Hélio Fraga, Fundação Oswaldo Cruz (Fiocruz)/Ministry of Health, Rio de Janeiro, Brazil
| | - Skaidrius Miliauskas
- Dept of Pulmonology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Liga Kuksa
- MDR-TB Dept, Riga East University Hospital for TB and Lung Disease Centre, Riga, Latvia
| | - Selene Manga
- Dept of Infectious Diseases, University National San Antonio Abad Cusco, Cusco, Peru
| | - Alena Skrahina
- Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | - Saulius Diktanas
- Tuberculosis Dept, 3rd Tuberculosis Unit, Republican Klaipėda Hospital, Klaipėda, Lithuania
| | | | - Alena Aleksa
- Dept of Phthisiology and Pulmonology, Grodno State Medical University, Grodno, Belarus
| | - Judith Bruchfeld
- Division of Infectious Diseases, Dept of Medicine, Karolinska Institute, Solna, Sweden.,Dept of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,These authors contributed equally
| | - Antoniya Koleva
- Pulmonology and Physiotherapy Dept, Gabrovo Lung Diseases Hospital, Gabrovo, Bulgaria
| | - Alberto Piubello
- Tuberculosis Division, International Union against Tuberculosis and Lung Disease (The Union), Paris, France.,Tuberculosis Division, Damien Foundation, Niamey, Niger.,These authors contributed equally
| | - Zarir Farokh Udwadia
- Dept of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, India
| | - 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, TB Center Beatrixoord, Haren, The Netherlands.,These authors contributed equally
| | - Evgeny Belilovski
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation
| | - Enrique Bernal
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Reina Sofia, Murcia, Spain
| | - Martin J Boeree
- Radboud University Medical Center, Center Dekkerswald, Nijmegen, The Netherlands
| | | | - Qingshan Cai
- Zhejiang Integrated Traditional and Western Medicine Hospital, Hangzhou, China
| | | | - Masoud Dara
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Edita Davidavičienė
- National TB Registry, Public Health Dept, Ministry of Health, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Lina Davies Forsman
- Division of Infectious Diseases, Dept of Medicine, Karolinska Institute, Solna, Sweden.,Dept of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Jorge De Los Rios
- Centro de Excelencia de TB "Niño Jesus", Servicio de Neumologia, Hospital Maria Auxiliadora, Lima, Peru
| | - Justin Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, Australia.,Dept of Microbiology and Immunology, University of Melbourne, Melbourne, Australia.,These authors contributed equally
| | - Jacinta Drakšienė
- Tuberculosis Dept, 3rd Tuberculosis Unit, Republican Klaipėda Hospital, Klaipėda, Lithuania
| | - Raquel Duarte
- National Reference Centre for MDR-TB, Hospital Centre Vila Nova de Gaia, Dept of Pneumology, Public Health Science and Medical Education Dept, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Nadia Escobar Salinas
- Division of Disease Prevention and Control, Dept of Communicable Diseases, National Tuberculosis Control and Elimination Programme, Ministry of Health, Santiago, Chile
| | - Maurizio Ferrarese
- TB Reference Centre, Villa Marelli Institute, Niguarda Hospital, Milan, Italy
| | - Alexey Filippov
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation
| | - Ana Garcia
- Pulmonology Division, Municipal Hospital F.J. Muñiz, Buenos Aires, Argentina
| | | | - Ieva Gaudiesiute
- Dept of Pulmonology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Regina Gayoso
- Reference Center Hélio Fraga, Fundação Oswaldo Cruz (Fiocruz)/Ministry of Health, Rio de Janeiro, Brazil
| | - Roscio Gomez Rosso
- National Institute of Respiratory and Environmental Diseases "Prof. Dr. Juan Max Boettner" Asunción, Paraguay
| | - Vygantas Gruslys
- Clinic of Chest Diseases, Immunology and Allergology, Vilnius University Medical Faculty, Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Gina Gualano
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Wouter Hoefsloot
- Radboud University Medical Center, Center Dekkerswald, Nijmegen, The Netherlands
| | - Jerker Jonsson
- Dept of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
| | - Elena Khimova
- Northern State Medical University, Arkhangelsk, Russian Federation
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Rafael Laniado-Laborín
- Universidad Autónoma de Baja California, Baja California, Mexico; Clínica de Tuberculosis del Hospital General de Tijuana, Tijuana, Mexico.,These authors contributed equally
| | - Yang Li
- Dept of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Cecile Magis-Escurra
- Radboud University Medical Center, Center Dekkerswald, Nijmegen, The Netherlands
| | | | - Valentina Marchese
- Clinic of Infectious and Tropical Diseases, WHO Collaborating Centre for TB elimination and TB/HIV co-infection, University of Brescia, Brescia, Italy
| | - Elena Martínez Robles
- Internal Medicine Dept, Tuberculosis Unit, Hospital de Cantoblanco - Hospital General Universitario La Paz, Madrid, Spain
| | - Alberto Matteelli
- Clinic of Infectious and Tropical Diseases, WHO Collaborating Centre for TB elimination and TB/HIV co-infection, University of Brescia, Brescia, Italy
| | - Jesica Mazza-Stalder
- Division of Pulmonary Medicine, University Hospital of Lausanne CHUV, Lausanne, Switzerland.,These authors contributed equally
| | - Charalampos Moschos
- Dept of Tuberculosis, Sotiria Athens Hospital of Chest Diseases, Athens, Greece
| | - Marcela Muñoz-Torrico
- Clínica de Tuberculosis, Instituto Nacional De Enfermedades Respiratorias Ismael Cosio Villegas, Ciudad De Mexico, Mexico.,These authors contributed equally
| | | | - Birutė Nakčerienė
- National TB Registry, Public Health Dept, Ministry of Health, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Laurent Nicod
- Division of Pulmonary Medicine, University Hospital of Lausanne CHUV, Lausanne, Switzerland
| | | | | | - Fabrizio Palmieri
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | | | - Marie-Christine Payen
- Division of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Agostina Pontarelli
- Reference Center for MDR-TB and HIV-TB, Eugenio Morelli Hospital, Sondalo, Italy
| | - Sarai Quirós
- Pneumology Dept, Tuberculosis Unit, Hospital de Cantoblanco - Hospital General Universitario La Paz, Madrid, Spain
| | - Adrian Rendon
- Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias CIPTIR, University Hospital of Monterrey UANL (Universidad Autonoma de Nuevo Leon), Monterrey, Mexico
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.,These authors contributed equally
| | - Agnese Šmite
- MDR-TB Dept, Riga East University Hospital for TB and Lung Disease Centre, Riga, Latvia
| | - Ivan Solovic
- National Institute for TB, Lung Diseases and Thoracic Surgery, Vysne Hagy, Catholic University Ruzomberok, Ruzomberok, Slovakia
| | | | - Marina Tadolini
- Unit of Infectious Diseases, Dept of Medical and Surgical Sciences Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Martin van den Boom
- World Health Organization Regional Office for Europe, Copenhagen, Denmark.,These authors contributed equally
| | - Marisa Vescovo
- Pulmonology Division, Municipal Hospital F.J. Muñiz, Buenos Aires, Argentina
| | - Pietro Viggiani
- Reference Center for MDR-TB and HIV-TB, Eugenio Morelli Hospital, Sondalo, Italy
| | - Askar Yedilbayev
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Rolandas Zablockis
- Clinic of Chest Diseases, Immunology and Allergology, Vilnius University Medical Faculty, Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Dmitry Zhurkin
- Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | - Matteo Zignol
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Dina Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy.,Dept of Medicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Italy.,These authors contributed equally
| | - Antonio Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy.,Dept of Medicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Italy
| | - José A Caminero
- Pneumology Dept, 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.,These authors contributed equally
| | - Jan-Willem Alffenaar
- University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, Australia.,Westmead Hospital, Sydney, Australia.,University of Groningen, University Medical Center Groningen, Dept of Pharmacy and Pharmacology, Groningen, The Netherlands.,These authors contributed equally
| | - Simon Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Dept of Infection, Royal London and Newham Hospitals, Barts Health NHS Trust, London, UK.,These authors contributed equally
| | - Rosella Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy.,These authors contributed equally
| | - Lia D'Ambrosio
- Public Health Consulting Group, Lugano, Switzerland.,These authors contributed equally
| | - Emanuele Pontali
- Dept of Infectious Diseases, Galliera Hospital, Genova, Italy.,These authors contributed equally
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.,These authors contributed equally
| | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy .,These authors contributed equally
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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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Nahid P, Mase SR, Migliori GB, Sotgiu G, Bothamley GH, Brozek JL, Cattamanchi A, Cegielski JP, Chen L, Daley CL, Dalton TL, Duarte R, Fregonese F, Horsburgh CR, Ahmad Khan F, Kheir F, Lan Z, Lardizabal A, Lauzardo M, Mangan JM, Marks SM, McKenna L, Menzies D, Mitnick CD, Nilsen DM, Parvez F, Peloquin CA, Raftery A, Schaaf HS, Shah NS, Starke JR, Wilson JW, Wortham JM, Chorba T, Seaworth B. Treatment of Drug-Resistant Tuberculosis. An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline. Am J Respir Crit Care Med 2019; 200:e93-e142. [PMID: 31729908 PMCID: PMC6857485 DOI: 10.1164/rccm.201909-1874st] [Citation(s) in RCA: 249] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: The American Thoracic Society, U.S. Centers for Disease Control and Prevention, European Respiratory Society, and Infectious Diseases Society of America jointly sponsored this new practice guideline on the treatment of drug-resistant tuberculosis (DR-TB). The document includes recommendations on the treatment of multidrug-resistant TB (MDR-TB) as well as isoniazid-resistant but rifampin-susceptible TB.Methods: Published systematic reviews, meta-analyses, and a new individual patient data meta-analysis from 12,030 patients, in 50 studies, across 25 countries with confirmed pulmonary rifampin-resistant TB were used for this guideline. Meta-analytic approaches included propensity score matching to reduce confounding. Each recommendation was discussed by an expert committee, screened for conflicts of interest, according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology.Results: Twenty-one Population, Intervention, Comparator, and Outcomes questions were addressed, generating 25 GRADE-based recommendations. Certainty in the evidence was judged to be very low, because the data came from observational studies with significant loss to follow-up and imbalance in background regimens between comparator groups. Good practices in the management of MDR-TB are described. On the basis of the evidence review, a clinical strategy tool for building a treatment regimen for MDR-TB is also provided.Conclusions: New recommendations are made for the choice and number of drugs in a regimen, the duration of intensive and continuation phases, and the role of injectable drugs for MDR-TB. On the basis of these recommendations, an effective all-oral regimen for MDR-TB can be assembled. Recommendations are also provided on the role of surgery in treatment of MDR-TB and for treatment of contacts exposed to MDR-TB and treatment of isoniazid-resistant TB.
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Caminero JA, García-Basteiro AL, Rendon A, Piubello A, Pontali E, Migliori GB. The future of drug-resistant tuberculosis treatment: learning from the past and the 2019 World Health Organization consolidated guidelines. Eur Respir J 2019; 54:54/4/1901272. [PMID: 31601719 DOI: 10.1183/13993003.01272-2019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/21/2019] [Indexed: 11/05/2022]
Affiliation(s)
- José A Caminero
- Pneumology Dept, General Hospital of Gran Canaria "Dr. Negrin", Las Palmas de Gran Canaria, Spain .,International Union against Tuberculosis and Lung Disease, Paris, France
| | - Alberto L García-Basteiro
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Adrián Rendon
- Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias - CIPTIR, Hospital Universitario de Monterrey, Universidad Autónoma de Nuevo León -UANL, Monterrey, México
| | - Alberto Piubello
- International Union against Tuberculosis and Lung Disease, Paris, France.,Tuberculosis Division, Damien Foundation, Niamey, Niger
| | | | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
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Mass spectrometry for therapeutic drug monitoring of anti-tuberculosis drugs. CLINICAL MASS SPECTROMETRY 2019; 14 Pt A:34-45. [DOI: 10.1016/j.clinms.2018.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 11/18/2022]
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36
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In vitro controlled release of tuberculosis drugs by amphiphilic branched copolymer nanoparticles. J IND ENG CHEM 2019. [DOI: 10.1016/j.jiec.2019.04.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ivanenkov YA, Yamidanov RS, Osterman IA, Sergiev PV, Aladinskiy VA, Aladinskaya AV, Terentiev VA, Veselov MS, Ayginin AA, Skvortsov DA, Komarova KS, Chemeris AV, Baimiev AK, Sofronova AA, Malyshev AS, Machulkin AE, Petrov RA, Bezrukov DS, Filkov GI, Puchinina MM, Zainullina LF, Maximova MA, Zileeva ZR, Vakhitova YV, Dontsova OA. Identification of N-Substituted Triazolo-azetidines as Novel Antibacterials using pDualrep2 HTS Platform. Comb Chem High Throughput Screen 2019; 22:346-354. [DOI: 10.2174/1386207322666190412165316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/19/2019] [Accepted: 03/22/2019] [Indexed: 12/17/2022]
Abstract
Aim and Objective:
Antibiotic resistance is a serious constraint to the development of new
effective antibacterials. Therefore, the discovery of the new antibacterials remains one of the main
challenges in modern medicinal chemistry. This study was undertaken to identify novel molecules with
antibacterial activity.
Materials and Methods:
Using our unique double-reporter system, in-house large-scale HTS campaign
was conducted for the identification of antibacterial potency of small-molecule compounds. The
construction allows us to visually assess the underlying mechanism of action. After the initial HTS and
rescreen procedure, luciferase assay, C14-test, determination of MIC value and PrestoBlue test were
carried out.
Results:
HTS rounds and rescreen campaign have revealed the antibacterial activity of a series of Nsubstituted
triazolo-azetidines and their isosteric derivatives that has not been reported previously. Primary
hit-molecule demonstrated a MIC value of 12.5 µg/mL against E. coli Δ tolC with signs of translation
blockage and no SOS-response. Translation inhibition (26%, luciferase assay) was achieved at high
concentrations up to 160 µg/mL, while no activity was found using C14-test. The compound did not
demonstrate cytotoxicity in the PrestoBlue assay against a panel of eukaryotic cells. Within a series of
direct structural analogues bearing the same or bioisosteric scaffold, compound 2 was found to have an
improved antibacterial potency (MIC=6.25 µg/mL) close to Erythromycin (MIC=2.5-5 µg/mL) against the
same strain. In contrast to the parent hit, this compound was more active and selective, and provided a
robust IP position.
Conclusion:
N-substituted triazolo-azetidine scaffold may be used as a versatile starting point for the
development of novel active and selective antibacterial compounds.
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Affiliation(s)
- Yan A. Ivanenkov
- Institute of Biochemistry and Genetics Russian Academy of Science (IBG RAS) Ufa Scientific Centre, Oktyabrya Prospekt 71, 450054, Ufa, Russian Federation
| | - Renat S. Yamidanov
- Institute of Biochemistry and Genetics Russian Academy of Science (IBG RAS) Ufa Scientific Centre, Oktyabrya Prospekt 71, 450054, Ufa, Russian Federation
| | - Ilya A. Osterman
- Skolkovo Institute of Science and Technology, Skolkovo, Russian Federation
| | - Petr V. Sergiev
- Skolkovo Institute of Science and Technology, Skolkovo, Russian Federation
| | | | | | - Victor A. Terentiev
- Institute of Biochemistry and Genetics Russian Academy of Science (IBG RAS) Ufa Scientific Centre, Oktyabrya Prospekt 71, 450054, Ufa, Russian Federation
| | - Mark S. Veselov
- Institute of Biochemistry and Genetics Russian Academy of Science (IBG RAS) Ufa Scientific Centre, Oktyabrya Prospekt 71, 450054, Ufa, Russian Federation
| | - Andrey A. Ayginin
- Institute of Biochemistry and Genetics Russian Academy of Science (IBG RAS) Ufa Scientific Centre, Oktyabrya Prospekt 71, 450054, Ufa, Russian Federation
| | - Dmitry A. Skvortsov
- Lomonosov Moscow State University, Department of Chemistry and A.N. Belozersky Institute of Physico-Chemical Biology, Moscow, Russian Federation
| | - Katerina S. Komarova
- Lomonosov Moscow State University, Department of Chemistry and A.N. Belozersky Institute of Physico-Chemical Biology, Moscow, Russian Federation
| | - Alexey V. Chemeris
- Institute of Biochemistry and Genetics Russian Academy of Science (IBG RAS) Ufa Scientific Centre, Oktyabrya Prospekt 71, 450054, Ufa, Russian Federation
| | - Alexey Kh. Baimiev
- Institute of Biochemistry and Genetics Russian Academy of Science (IBG RAS) Ufa Scientific Centre, Oktyabrya Prospekt 71, 450054, Ufa, Russian Federation
| | - Alina A. Sofronova
- Lomonosov Moscow State University, Faculty of Bioengineering and Bioinformatics, Moscow, Russian Federation
| | | | - Alexey E. Machulkin
- Lomonosov Moscow State University, Chemistry Dept, Leninskie gory, Building 1/3, GSP-1, Moscow, 119991, Russian Federation
| | - Rostislav A. Petrov
- Lomonosov Moscow State University, Chemistry Dept, Leninskie gory, Building 1/3, GSP-1, Moscow, 119991, Russian Federation
| | - Dmitry S. Bezrukov
- Lomonosov Moscow State University, Chemistry Dept, Leninskie gory, Building 1/3, GSP-1, Moscow, 119991, Russian Federation
| | - Gleb I. Filkov
- Moscow Institute of Physics and Technology (State University), 9 Institutskiy lane, Dolgoprudny City, Moscow Region, 141700, Russian Federation
| | - Maria M. Puchinina
- Moscow Institute of Physics and Technology (State University), 9 Institutskiy lane, Dolgoprudny City, Moscow Region, 141700, Russian Federation
| | - Liana F. Zainullina
- Institute of Biochemistry and Genetics Russian Academy of Science (IBG RAS) Ufa Scientific Centre, Oktyabrya Prospekt 71, 450054, Ufa, Russian Federation
| | - Marina A. Maximova
- Institute of Biochemistry and Genetics Russian Academy of Science (IBG RAS) Ufa Scientific Centre, Oktyabrya Prospekt 71, 450054, Ufa, Russian Federation
| | - Zulfiya R. Zileeva
- Institute of Biochemistry and Genetics Russian Academy of Science (IBG RAS) Ufa Scientific Centre, Oktyabrya Prospekt 71, 450054, Ufa, Russian Federation
| | - Yulia V. Vakhitova
- Institute of Biochemistry and Genetics Russian Academy of Science (IBG RAS) Ufa Scientific Centre, Oktyabrya Prospekt 71, 450054, Ufa, Russian Federation
| | - Olga A. Dontsova
- Lomonosov Moscow State University, Chemistry Dept, Leninskie gory, Building 1/3, GSP-1, Moscow, 119991, Russian Federation
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2-Pyrazol-1-yl-thiazole derivatives as novel highly potent antibacterials. J Antibiot (Tokyo) 2019; 72:827-833. [DOI: 10.1038/s41429-019-0211-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/23/2019] [Accepted: 06/16/2019] [Indexed: 02/06/2023]
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Pontali E, Raviglione MC, Migliori GB. Regimens to treat multidrug-resistant tuberculosis: past, present and future perspectives. Eur Respir Rev 2019; 28:28/152/190035. [PMID: 31142549 DOI: 10.1183/16000617.0035-2019] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/28/2019] [Indexed: 11/05/2022] Open
Abstract
Over the past few decades, treatment of multidrug-resistant (MDR)/extensively drug-resistant (XDR) tuberculosis (TB) has been challenging because of its prolonged duration (up to 20-24 months), toxicity, costs and sub-optimal outcomes.After over 40 years of neglect, two new drugs (bedaquiline and delamanid) have been made available to manage difficult-to-treat MDR-/XDR-TB cases. World Health Organization (WHO) guidelines published in March 2019 endorsed the possibility of treating MDR-TB patients with a full oral regimen, following previous guidelines published in 2016 which launched a shorter regimen lasting 9-10 months.The objectives of this article are to review the main achievements in MDR-TB treatment through the description of the existing WHO strategies, to discuss the main ongoing trials and to shed light on potential future scenarios and revised definitions necessary to manage drug-resistant TB.
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Affiliation(s)
| | | | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
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Akkerman O, Aleksa A, Alffenaar JW, Al-Marzouqi NH, Arias-Guillén M, Belilovski E, Bernal E, Boeree MJ, Borisov SE, Bruchfeld J, Cadiñanos Loidi J, Cai Q, Caminero JA, Cebrian Gallardo JJ, Centis R, Codecasa LR, D'Ambrosio L, Dalcolmo M, Danila E, Dara M, Davidavičienė E, Davies Forsman L, De Los Rios Jefe J, Denholm J, Duarte R, Elamin SE, Ferrarese M, Filippov A, Ganatra S, Garcia A, García-García JM, Gayoso R, Giraldo Montoya AM, Gomez Rosso RG, Gualano G, Hoefsloot W, Ilievska-Poposka B, Jonsson J, Khimova E, Kuksa L, Kunst H, Laniado-Laborín R, Li Y, Magis-Escurra C, Manfrin V, Manga S, Marchese V, Martínez Robles E, Maryandyshev A, Matteelli A, Migliori GB, Mullerpattan JB, Munoz-Torrico M, Mustafa Hamdan H, Nieto Marcos M, Noordin NM, Palmero DJ, Palmieri F, Payen MC, Piubello A, Pontali E, Pontarelli A, Quirós S, Rendon A, Skrahina A, Šmite A, Solovic I, Sotgiu G, Souleymane MB, Spanevello A, Stošić M, Tadolini M, Tiberi S, Udwadia ZF, van den Boom M, Vescovo M, Viggiani P, Visca D, Zhurkin D, Zignol M. Surveillance of adverse events in the treatment of drug-resistant tuberculosis: A global feasibility study. Int J Infect Dis 2019; 83:72-76. [PMID: 30953827 DOI: 10.1016/j.ijid.2019.03.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 03/29/2019] [Accepted: 03/29/2019] [Indexed: 10/27/2022] Open
Abstract
The World Health Organization launched a global initiative, known as aDSM (active TB drug safety monitoring and management) to better describe the safety profile of new treatment regimens for drug-resistant tuberculosis (TB) in real-world settings. However, comprehensive surveillance is difficult to implement in several countries. The aim of the aDSM project is to demonstrate the feasibility of implementing national aDSM registers and to describe the type and the frequency of adverse events (AEs) associated with exposure to the new anti-TB drugs. Following a pilot study carried out in 2016, official involvement of TB reference centres/countries into the project was sought and cases treated with bedaquiline- and/or delamanid-containing regimens were consecutively recruited. AEs were prospectively collected ensuring potential attribution of the AE to a specific drug based on its known safety profile. A total of 309 cases were fully reported from 41 centres in 27 countries (65% males; 268 treated with bedaquiline, 20 with delamanid, and 21 with both drugs) out of an estimated 781 cases the participating countries had committed to report by the first quarter of 2019.
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Affiliation(s)
- Onno Akkerman
- University of Groningen, University Medical Center Groningen, Tuberculosis Center Beatrixoord, Haren, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases & Tuberculosis, Groningen, The Netherlands.
| | - Alena Aleksa
- Department of Phthisiology, Grodno State Medical University, GRCC "Phthisiology", Grodno, Belarus.
| | - Jan-Willem Alffenaar
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Westmead Hospital, Sydney, Australia; Dept. Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands.
| | - Nada Hassan Al-Marzouqi
- Preventive Medicine Department, Ministry of Health and Prevention, Dubai, United Arab Emirates.
| | - Miguel Arias-Guillén
- Servicio de Neumología, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias CIBER-Enfermedades Respiratorias. Instituto de Salud Carlos III, Oviedo Spain.
| | - Evgeny Belilovski
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation.
| | - Enrique Bernal
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Reina Sofia, Murcia, Spain.
| | - Martin J Boeree
- Department of Pulmonary Diseases, Radboud Center of Infectious Diseases, Tuberculosis Center Dekkerswald Groesbeek, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Sergey E Borisov
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation.
| | - Judith Bruchfeld
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institute, Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
| | - Julen Cadiñanos Loidi
- Internal Medicine Department, Hospital General de Villalba, Collado Villalba, Spain.
| | - Qingshan Cai
- Zhejiang Integrated Traditional and Western Medicine Hospital, Hangzhou, China.
| | - Jose A Caminero
- 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.
| | | | - Rosella Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy.
| | | | | | - Margareth Dalcolmo
- Reference Center Hélio Fraga, Fundação Oswaldo Cruz (Fiocruz)/Ministry of Health, Rio de Janeiro, Brazil.
| | - Edvardas Danila
- Clinic of Chest Diseases, Immunology and Allergology, Vilnius University Medical Faculty, Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
| | - Masoud Dara
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark.
| | - Edita Davidavičienė
- National TB registry, Public Health Department, Ministry of Health; Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
| | - Lina Davies Forsman
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institute, Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
| | | | - Justin Denholm
- Victorian Tuberculosis Program, Melbourne Health; Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
| | - Raquel 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.
| | | | - Maurizio Ferrarese
- TB Reference Centre, Villa Marelli Institute/Niguarda Hospital, Milan, Italy.
| | - Alexey Filippov
- Moscow Research and Clinical Center for TB Control, Moscow Government's Health Department, Moscow, Russian Federation.
| | - Shashank Ganatra
- Department of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, India.
| | - Ana Garcia
- Pulmonology Division, Municipal Hospital F.J. Muñiz, Buenos Aires, Argentina.
| | | | - Regina Gayoso
- Reference Center Hélio Fraga, Fundação Oswaldo Cruz (Fiocruz)/Ministry of Health, Rio de Janeiro, Brazil.
| | | | - Roscio Gomez Gomez Rosso
- National Institute of Respiratory and Environmental Diseases "Prof. Dr. Juan Max Boettner" Asunción, Paraguay.
| | - Gina Gualano
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy.
| | - Wouter Hoefsloot
- Department of Pulmonary Diseases, Radboud Center of Infectious Diseases, Tuberculosis Center Dekkerswald Groesbeek, Radboud University Medical Center, Nijmegen, The Netherlands.
| | | | - Jerker Jonsson
- National TB Surveillance Unit, Public Health Agency, Stockholm, Sweden.
| | - Elena Khimova
- Northern State Medical University, Arkhangelsk, Russian Federation.
| | - Liga Kuksa
- MDR-TB department, Riga East University Hospital for TB and Lung Disease Centre, Riga, Latvia.
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
| | - Rafael Laniado-Laborín
- Universidad Autónoma de Baja California, Baja California, Mexico; Clínica de Tuberculosis del Hospital General de Tijuana, Tijuana, Baja California, Mexico.
| | - Yang Li
- Departments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.
| | - Cecile Magis-Escurra
- Department of Pulmonary Diseases, Radboud Center of Infectious Diseases, Tuberculosis Center Dekkerswald Groesbeek, Radboud University Medical Center, Nijmegen, The Netherlands.
| | | | - Selene Manga
- Department of Infectious Diseases, University National San Antonio Abad Cusco, Cusco, Peru.
| | - Valentina Marchese
- University Department 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.
| | - Elena Martínez Robles
- Internal Medicine Department, Tuberculosis Hospital de Cantoblanco- Hospital La Paz, Madrid, Spain
| | | | - Alberto Matteelli
- University Department 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.
| | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy.
| | - Jai B Mullerpattan
- Department of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, India.
| | - Marcela Munoz-Torrico
- Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, Mexico.
| | | | | | | | | | - Fabrizio Palmieri
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy.
| | - Marie-Christine Payen
- Division of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Alberto Piubello
- Tuberculosis Division, International Union against Tuberculosis and Lung Disease (The Union), Paris, France; Tuberculosis Division, Damien Foundation, Niamey, Niger.
| | - Emanuele Pontali
- Department of Infectious Diseases, Galliera Hospital, Genova, Italy.
| | - Agostina Pontarelli
- Reference Centre for MDR and HIV-TB, Eugenio Morelli Hospital, Sondalo, Italy.
| | - Sarai Quirós
- Pneumology Department, Tuberculosis Unit, Hospital de Cantoblanco- Hospital General Universitario La Paz, Madrid, Spain.
| | - Adrian Rendon
- Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias CIPTIR, University Hospital of Monterrey UANL (Universidad Autonoma de Nuevo Leon), Monterrey, Mexico.
| | - Alena Skrahina
- Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus.
| | - Agnese Šmite
- MDR-TB department, Riga East University Hospital for TB and Lung Disease Centre, Riga, Latvia.
| | - Ivan Solovic
- National Institute for TB, Lung Diseases and Thoracic Surgery, Vysne Hagy, Catholic University Ruzomberok, Slovakia.
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of z, University of Sassari, Sassari, Italy.
| | | | - Antonio Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy; Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese, Italy.
| | - Maja Stošić
- TB Programme and Surveillance Unit, National Public Health Institute, Belgrade, Serbia.
| | - Marina Tadolini
- Unit of Infectious Diseases, Deparment of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Simon Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
| | - Zarir Farokh Udwadia
- Department of Respiratory Medicine, P.D. Hinduja National Hospital and MRC, Mumbai, India.
| | | | - Marisa Vescovo
- Pulmonology Division, Municipal Hospital F.J. Muñiz, Buenos Aires, Argentina.
| | - Pietro Viggiani
- Reference Centre for MDR and HIV-TB, Eugenio Morelli Hospital, Sondalo, Italy.
| | - Dina Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy; Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese, Italy.
| | - Dmitry Zhurkin
- Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus.
| | - Matteo Zignol
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland.
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Tiberi S, Pontali E, Tadolini M, D’Ambrosio L, Migliori GB. Challenging MDR-TB clinical problems – The case for a new Global TB Consilium supporting the compassionate use of new anti-TB drugs. Int J Infect Dis 2019; 80S:S68-S72. [DOI: 10.1016/j.ijid.2019.01.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 11/29/2022] Open
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Delamanid: does it have a role in tuberculosis treatment? THE LANCET RESPIRATORY MEDICINE 2019; 7:193-195. [DOI: 10.1016/s2213-2600(18)30455-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 11/19/2022]
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Pontali E, Centis R, D'Ambrosio L, Toscanini F, Migliori GB. Recent evidence on delamanid use for rifampicin-resistant tuberculosis. J Thorac Dis 2019; 11:S457-S460. [PMID: 30997247 DOI: 10.21037/jtd.2018.11.26] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Emanuele Pontali
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | - Rosella Centis
- Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | | | - Federica Toscanini
- Department of Infectious Diseases, IRCCS AOU San Martino-IST, Genoa, Italy
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Efficacy and safety of delamanid in combination with an optimised background regimen for treatment of multidrug-resistant tuberculosis: a multicentre, randomised, double-blind, placebo-controlled, parallel group phase 3 trial. THE LANCET RESPIRATORY MEDICINE 2019; 7:249-259. [PMID: 30630778 DOI: 10.1016/s2213-2600(18)30426-0] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Delamanid is one of two recently approved drugs for the treatment of multidrug-resistant tuberculosis. We aimed to evaluate the safety and efficacy of delamanid in the first 6 months of treatment. METHODS This randomised, double-blind, placebo-controlled, phase 3 trial was done at 17 sites in seven countries (Estonia, Latvia, Lithuania, Moldova, Peru, the Philippines, and South Africa). We enrolled eligible adults (>18 years) with pulmonary multidrug-resistant tuberculosis to receive, in combination with an optimised background regimen developed according to WHO and national guidelines, either oral delamanid (100 mg twice daily) for 2 months followed by 200 mg once daily for 4 months or placebo (same regimen). Patients were centrally randomised (2:1) and stratified by risk category for delayed sputum culture conversion. Primary outcomes were the time to sputum culture conversion over 6 months and the difference in the distribution of time to sputum culture conversion over 6 months between the two groups, as assessed in the modified intention-to-treat population. The trial is registered at ClinicalTrials.gov, number NCT01424670. FINDINGS Between Sept 2, 2011, and Nov 27, 2013, we screened 714 patients, of whom 511 were randomly assigned (341 to delamanid plus optimised background regimen [delamanid group] and 170 to placebo plus optimised background regimen [placebo group]) and formed the safety analysis population. 327 patients were culture-positive for multidrug-resistant tuberculosis at baseline and comprised the efficacy analysis population (226 in the delamanid group and 101 in the placebo group). Median time to sputum culture conversion did not differ between the two groups (p=0·0562; modified Peto-Peto), with 51 days (IQR 29-98) in the delamanid group and 57 days (43-85) in the placebo group; the hazard ratio was 1·17 (95% CI 0·91-1·51, p=0·2157). 501 (98·0%) of 511 patients had at least one treatment-emergent adverse event. 136 (26·6%) of 511 patients had at least one serious treatment-emergent adverse event; the incidence was similar between treatment groups (89 [26·1%] of 341 patients for delamanid and 47 [27·6%] of 170 for placebo). Deaths related to treatment-emergent adverse events were similar between groups (15 [4·4%] of 341 for delamanid and six [3·5%] of 170 for placebo). No deaths were considered to be related to delamanid. INTERPRETATION The reduction in median time to sputum culture conversion over 6 months was not significant in the primary analysis. Delamanid was well tolerated with a highly characterised safety profile. Further evaluation of delamanid is needed to determine its role in a rapidly evolving standard of care. FUNDING Otsuka Pharmaceutical.
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Migliori GB. Evolution of Programmatic Definitions Used in Tuberculosis Prevention and Care. Clin Infect Dis 2018; 68:1787-1789. [DOI: 10.1093/cid/ciy990] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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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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Gandhi NR, Brust JCM, Shah NS. A new era for treatment of drug-resistant tuberculosis. Eur Respir J 2018; 52:52/4/1801350. [PMID: 30287493 DOI: 10.1183/13993003.01350-2018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 08/04/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Neel R Gandhi
- Rollins School of Public Health and Emory School of Medicine, Emory University, Atlanta, GA, USA
| | - James C M Brust
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - N Sarita Shah
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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