1
|
Shaw ES, Stoker NG, Potter JL, Claassen H, Leslie A, Tweed CD, Chiang CY, Conradie F, Esmail H, Lange C, Pinto L, Rucsineanu O, Sloan DJ, Theron G, Tisile P, Voo TC, Warren RM, Lebina L, Lipman M. Bedaquiline: what might the future hold? THE LANCET. MICROBE 2024:100909. [PMID: 39074472 DOI: 10.1016/s2666-5247(24)00149-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 07/31/2024]
Abstract
Tuberculosis drug development has stagnated for decades, so the recent availability of bedaquiline is welcome. Bedaquiline-containing regimens, now the first-line therapy recommended by WHO, have transformed the treatment of drug-resistant tuberculosis, offering safer and more effective oral treatment options. However, key obstacles need to be overcome to ensure global access and prevent the rapid development of resistance against this promising class of drugs. In this Personal View, building on an international workshop held in 2023, we evaluate the current evidence and suggest possible ways forward, recognising the tension between increasing use and slowing the rise of resistance. We also discuss problems in accessing bedaquiline-containing regimens, the potential widening of their use beyond drug-resistant tuberculosis, and lessons for utilising new drugs as they are developed.
Collapse
Affiliation(s)
- Emily S Shaw
- Division of Acute Medical Services, University College London Hospitals NHS Foundation Trust, London, UK.
| | - Neil G Stoker
- Centre for Clinical Microbiology, Royal Free Campus, University College London, London, UK
| | - Jessica L Potter
- Respiratory Medicine, Division of Medicine, University College London, London, UK; Department of Respiratory Medicine, North Middlesex University Hospital, London, UK
| | | | - Alasdair Leslie
- Department of Infection and Immunity, University College London, London, UK; Africa Health Research Institute, Durban, South Africa
| | - Conor D Tweed
- MRC Clinical Trials Unit, University College London, London, UK
| | - Chen-Yuan Chiang
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Francesca Conradie
- Clinical HIV Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hanif Esmail
- MRC Clinical Trials Unit, University College London, London, UK; Institute for Global Health, University College London, London, UK; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Christoph Lange
- Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany; German Center of Infection Research (DZIF), Borstel, Germany; Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Lancelot Pinto
- PD Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Oxana Rucsineanu
- Moldova National Association of Tuberculosis Patients (SMIT), Bălți, Republic of Moldova
| | - Derek J Sloan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Grant Theron
- Department of Science and Innovation-National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | | | - Robin M Warren
- Department of Science and Innovation - National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Cape Town, South Africa; South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Marc Lipman
- Respiratory Medicine, Division of Medicine, University College London, London, UK; Royal Free London NHS Foundation Trust, London, UK
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Perumal R, Bionghi N, Nimmo C, Letsoalo M, Cummings MJ, Hopson M, Wolf A, Jubaer SA, Padayatchi N, Naidoo K, Larsen MH, O'Donnell M. Baseline and treatment-emergent bedaquiline resistance in drug-resistant tuberculosis: a systematic review and meta-analysis. Eur Respir J 2023; 62:2300639. [PMID: 37945030 PMCID: PMC11035900 DOI: 10.1183/13993003.00639-2023] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Abstract
Bedaquiline resistance is a major threat to drug-resistant tuberculosis control strategies. This analysis found a pooled prevalence of baseline bedaquiline resistance of 2.4% and a pooled prevalence of treatment-emergent bedaquiline resistance of 2.1%. https://bit.ly/3FC6yio
Collapse
Affiliation(s)
- Rubeshan Perumal
- CAPRISA MRC-HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
- Division of Pulmonology and Critical Care, Department of Medicine, University of KwaZulu-Natal, Durban, South Africa
- These authors contributed equally to this work
| | - Neda Bionghi
- Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
- These authors contributed equally to this work
| | | | - Marothi Letsoalo
- CAPRISA MRC-HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
| | - Matthew J Cummings
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Madeleine Hopson
- Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Allison Wolf
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Shamim Al Jubaer
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nesri Padayatchi
- CAPRISA MRC-HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
| | - Kogieleum Naidoo
- CAPRISA MRC-HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
| | - Michelle H Larsen
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
- These authors contributed equally to this work
| | - Max O'Donnell
- CAPRISA MRC-HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
- These authors contributed equally to this work
| |
Collapse
|
4
|
Prasad R, Singh A, Gupta N. Can Pan-TB shorter regimens be a promising hope for ending TB in India by 2025 in ongoing COVID-19 era? Indian J Tuberc 2022; 69:377-382. [PMID: 36460365 PMCID: PMC9221684 DOI: 10.1016/j.ijtb.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Rajendra Prasad
- Department of Pulmonary Medicine, Era Medical College, Lucknow, Uttar Pradesh, India.
| | - Abhijeet Singh
- Department of Pulmonary & Critical Care Medicine, Fortis Hospital, Vasant Kunj, New Delhi, India
| | - Nikhil Gupta
- Department of Internal Medicine, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|
5
|
Mallick JS, Nair P, Abbew ET, Van Deun A, Decroo T. OUP accepted manuscript. JAC Antimicrob Resist 2022; 4:dlac029. [PMID: 35356403 PMCID: PMC8963286 DOI: 10.1093/jacamr/dlac029] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/27/2022] [Indexed: 12/02/2022] Open
Abstract
Background Drug-resistant tuberculosis (DR-TB) is considered to be a public health threat and is difficult to cure, requiring a lengthy treatment with potent, potentially toxic drugs. The novel antimicrobial agent bedaquiline has shown promising results for patients with DR-TB, improving the rate of culture conversion and reducing TB-related mortality. However, increasing numbers of cases with acquired bedaquiline resistance (ABR) have been reported in recent years. Methods This systematic review aimed to assess the frequency of ABR and characteristics of patients acquiring it. Studies showing data on sequential bedaquiline drug-susceptibility testing in patients treated with a bedaquiline-containing regimen were included. The databases CENTRAL, PubMed and Embase were manually searched, and 866 unique records identified, eventually leading to the inclusion of 13 studies. Phenotypic ABR was assessed based on predefined MIC thresholds and genotypic ABR based on the emergence of resistance-associated variants. Results The median (IQR) frequency of phenotypic ABR was 2.2% (1.1%–4.6%) and 4.4% (1.8%–5.8%) for genotypic ABR. Among the studies reporting individual data of patients with ABR, the median number of likely effective drugs in a treatment regimen was five, in accordance with WHO recommendations. In regard to the utilization of important companion drugs with high and early bactericidal activity, linezolid was included in the regimen of most ABR patients, whereas the usage of other group A (fluoroquinolones) and former group B drugs (second-line injectable drugs) was rare. Conclusions Our findings suggest a relevant frequency of ABR, urging for a better protection against it. Therefore, treatment regimens should include drugs with high resistance-preventing capacity through high and early bactericidal activity.
Collapse
Affiliation(s)
- Jahan Saeed Mallick
- Institute of Tropical Medicine Antwerp, Department of Clinical Sciences, Kronenburgstraat 43, 2000 Antwerpen, Belgium
- Corresponding author. E-mail:
| | - Parvati Nair
- Institute of Tropical Medicine Antwerp, Department of Clinical Sciences, Kronenburgstraat 43, 2000 Antwerpen, Belgium
| | - Elizabeth Tabitha Abbew
- Institute of Tropical Medicine Antwerp, Department of Clinical Sciences, Kronenburgstraat 43, 2000 Antwerpen, Belgium
- Cape Coast Teaching Hospital, Interberton Road, Cape Coast, Ghana
| | | | - Tom Decroo
- Institute of Tropical Medicine Antwerp, Department of Clinical Sciences, Kronenburgstraat 43, 2000 Antwerpen, Belgium
| |
Collapse
|
6
|
Kendall EA, Malhotra S, Cook-Scalise S, Denkinger CM, Dowdy DW. Estimating the impact of a novel drug regimen for treatment of tuberculosis: a modeling analysis of projected patient outcomes and epidemiological considerations. BMC Infect Dis 2019; 19:794. [PMID: 31500572 PMCID: PMC6734288 DOI: 10.1186/s12879-019-4429-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 08/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Regimens that could treat both rifampin-resistant (RR) and rifampin-susceptible tuberculosis (TB) while shortening the treatment duration have reached late-stage clinical trials. Decisions about whether and how to implement such regimens will require an understanding of their likely clinical impact and how this impact depends on local epidemiology and implementation strategy. METHODS A Markov state-transition model of 100,000 representative South African adults with TB was used to simulate implementation of the regimen BPaMZ (bedaquiline, pretomanid, moxifloxacin, and pyrazinamide), either for RR-TB only or universally for all patients. Patient outcomes, including cure rates, time with active TB, and time on treatment, were compared to outcomes under current care. Sensitivity analyses varied the drug-resistance epidemiology, rifampin susceptibility testing practices, and regimen efficacy. RESULTS Using BPaMZ exclusively for RR-TB increased the proportion of all RR-TB that was cured by initial treatment from 60 ± 1% to 67 ± 1%. Expanding use of BPaMZ to all patients increased cure of RR-TB to 89 ± 1% and cure of all TB from 87.3 ± 0.1% to 89.5 ± 0.1%, while shortening treatment by 1.9 months/person. In sensitivity analyses, reducing the coverage of rifampin susceptibility testing resulted in lower projected proportions of patients cured under all regimen scenarios (current care, RR-only BPaMZ, and universal BPaMZ), compared to the proportions projected using South Africa's high coverage; however, this reduced coverage resulted in greater expected incremental benefits of universal BPaMZ implementation, both when compared to RR-only BPaMZ implementation and when compared to to current care under the same low rifampin susceptibility testing coverage. In settings with higher RR-TB prevalence, the benefits of BPaMZ were magnified both for RR-specific and universal BPaMZ implementation. CONCLUSIONS Novel regimens such as BPaMZ could improve RR-TB outcomes and shorten treatment for all patients, particularly with universal use. Decision-makers weighing early options for implementing such regimens at scale will want to consider the expected impact on patient outcomes and on the burden of treatment in their local context.
Collapse
Affiliation(s)
- Emily A Kendall
- Division of Infectious Diseases and Center for Tuberculosis Research, Johns Hopkins University School of Medicine, CRB2 Room 106, 1550 Orleans St, Baltimore, MD, 21287, USA.
| | - Shelly Malhotra
- Global Alliance for TB Drug Development, New York, NY, USA
- International AIDS Vaccine Initiative, New York, NY, USA
| | | | - Claudia M Denkinger
- Division of Tropical Medicine, Center of Infectious Disease, Heidelberg University, Heidelberg, Germany
- Tuberculosis Programme, FIND, Geneva, Switzerland
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
7
|
Lewnard JA, Reingold AL. Emerging Challenges and Opportunities in Infectious Disease Epidemiology. Am J Epidemiol 2019; 188:873-882. [PMID: 30877295 PMCID: PMC7109842 DOI: 10.1093/aje/kwy264] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 12/12/2022] Open
Abstract
Much of the intellectual tradition of modern epidemiology stems from efforts to understand and combat chronic diseases persisting through the 20th century epidemiologic transition of countries such as the United States and United Kingdom. After decades of relative obscurity, infectious disease epidemiology has undergone an intellectual rebirth in recent years amid increasing recognition of the threat posed by both new and familiar pathogens. Here, we review the emerging coalescence of infectious disease epidemiology around a core set of study designs and statistical methods bearing little resemblance to the chronic disease epidemiology toolkit. We offer our outlook on challenges and opportunities facing the field, including the integration of novel molecular and digital information sources into disease surveillance, the assimilation of such data into models of pathogen spread, and the increasing contribution of models to public health practice. We next consider emerging paradigms in causal inference for infectious diseases, ranging from approaches to evaluating vaccines and antimicrobial therapies to the task of ascribing clinical syndromes to etiologic microorganisms, an age-old problem transformed by our increasing ability to characterize human-associated microbiota. These areas represent an increasingly important component of epidemiology training programs for future generations of researchers and practitioners.
Collapse
Affiliation(s)
- Joseph A Lewnard
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California
- Correspondence to Dr. Joseph A. Lewnard, Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA 94720 (e-mail: )
| | - Arthur L Reingold
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California
| |
Collapse
|
8
|
Ionescu AM, Mpobela Agnarson A, Kambili C, Metz L, Kfoury J, Wang S, Williams A, Singh V, Thomas A. Bedaquiline- versus injectable-containing drug-resistant tuberculosis regimens: a cost-effectiveness analysis. Expert Rev Pharmacoecon Outcomes Res 2018; 18:677-689. [PMID: 30073886 DOI: 10.1080/14737167.2018.1507821] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Drug-resistant tuberculosis (DR-TB) continues to be a major public health challenge with suboptimal treatment outcomes including well-documented treatment-related toxicities. We compared the cost-effectiveness of bedaquiline (BDQ) containing regimens with injectable containing regimens (short-course regimen [SCR] and long-course regiman [LCR]) in India, Russia, and South Africa. METHODS The analysis evaluated the direct costs of DR-TB treatment which included drugs, hospitalization, injectable-related adverse event costs, and other costs. Scenarios altered regimen costs, SCR/LCR ratio, and substitution rate between regimens (whether BDQ or injectable containing). RESULTS BDQ containing regimens are more cost effective based on cost per treatment success compared with injectable containing regimens, reducing these in SCR by 18-20% and in LCR by 49-54%. Average cost effectiveness ratios (ACERs) of BDQ containing regimens are lower. The incremental cost effectiveness ratio (ICER) is negative. Exclusive use of BDQ containing regimens results in approximately 61,000 more patients treated successfully over 5 years. CONCLUSIONS Across all countries, BDQ containing regimens are dominant compared to injectable containing regimens, entailing lower treatment costs to achieve better clinical outcomes. This analysis can provide insight and support to local and global decision-makers and public health organizations to allocate efficiently resources improving patient and public health outcomes.
Collapse
Affiliation(s)
| | | | - Chrispin Kambili
- b Johnson & Johnson Global Public Health , South Raritan , NJ , USA
| | - Laurent Metz
- c Johnson & Johnson Global Public Health , Asia Pacific , Singapore
| | | | | | - Abeda Williams
- f Pharmaceutical Division of Johnson and Johnson , Janssen Pharmaceutica South Africa , Johannesburg , South Africa
| | - Vikram Singh
- g Janssen India, Pharmaceutical Division of Johnson and Johnson Pvt. Ltd ., India
| | - Adrian Thomas
- a Johnson & Johnson Global Public Health , New Brunswick , NJ , USA
| |
Collapse
|
9
|
Population implications of the use of bedaquiline in people with extensively drug-resistant tuberculosis: are fears of resistance justified? THE LANCET. INFECTIOUS DISEASES 2017; 17:e429-e433. [DOI: 10.1016/s1473-3099(17)30299-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/10/2017] [Accepted: 04/11/2017] [Indexed: 11/24/2022]
|