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du Cros P, Greig J, Alffenaar JWC, Cross GB, Cousins C, Berry C, Khan U, Phillips PPJ, Velásquez GE, Furin J, Spigelman M, Denholm JT, Thi SS, Tiberi S, Huang GKL, Marks GB, Turkova A, Guglielmetti L, Chew KL, Nguyen HT, Ong CWM, Brigden G, Singh KP, Motta I, Lange C, Seddon JA, Nyang'wa BT, Maug AKJ, Gler MT, Dooley KE, Quelapio M, Tsogt B, Menzies D, Cox V, Upton CM, Skrahina A, McKenna L, Horsburgh CR, Dheda K, Marais BJ. Standards for clinical trials for treating TB. Int J Tuberc Lung Dis 2023; 27:885-898. [PMID: 38042969 PMCID: PMC10719894 DOI: 10.5588/ijtld.23.0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/21/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND: The value, speed of completion and robustness of the evidence generated by TB treatment trials could be improved by implementing standards for best practice.METHODS: A global panel of experts participated in a Delphi process, using a 7-point Likert scale to score and revise draft standards until consensus was reached.RESULTS: Eleven standards were defined: Standard 1, high quality data on TB regimens are essential to inform clinical and programmatic management; Standard 2, the research questions addressed by TB trials should be relevant to affected communities, who should be included in all trial stages; Standard 3, trials should make every effort to be as inclusive as possible; Standard 4, the most efficient trial designs should be considered to improve the evidence base as quickly and cost effectively as possible, without compromising quality; Standard 5, trial governance should be in line with accepted good clinical practice; Standard 6, trials should investigate and report strategies that promote optimal engagement in care; Standard 7, where possible, TB trials should include pharmacokinetic and pharmacodynamic components; Standard 8, outcomes should include frequency of disease recurrence and post-treatment sequelae; Standard 9, TB trials should aim to harmonise key outcomes and data structures across studies; Standard 10, TB trials should include biobanking; Standard 11, treatment trials should invest in capacity strengthening of local trial and TB programme staff.CONCLUSION: These standards should improve the efficiency and effectiveness of evidence generation, as well as the translation of research into policy and practice.
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Affiliation(s)
- P du Cros
- Burnet Institute, Melbourne, VIC, Monash Infectious Diseases, Monash Health, Melbourne, VIC, Australia
| | - J Greig
- Burnet Institute, Melbourne, VIC, Médecins Sans Frontières (MSF), Manson Unit, London, UK
| | - J-W C Alffenaar
- Sydney Infectious Diseases Institute (Sydney ID), and, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Westmead Hospital, Sydney, NSW
| | - G B Cross
- Burnet Institute, Melbourne, VIC, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - C Cousins
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - C Berry
- Médecins Sans Frontières (MSF), Manson Unit, London, UK
| | - U Khan
- Interactive Research and Development Global, Singapore City, Singapore
| | - P P J Phillips
- UCSF Center for Tuberculosis, Division of Pulmonary and Critical Care Medicine, and
| | - G E Velásquez
- UCSF Center for Tuberculosis, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA
| | - J Furin
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA
| | - M Spigelman
- Global Alliance for TB Drug Development, New York, NY, USA
| | - J T Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC, Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - S S Thi
- Eswatini National TB Control Program, Mbabane, Kingdom of Eswatini
| | - S Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, GlaxoSmithKline, London, UK
| | - G K L Huang
- Burnet Institute, Melbourne, VIC, Northern Health Infectious Diseases, Northern Health, Melbourne, VIC
| | - G B Marks
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - A Turkova
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - L Guglielmetti
- Médecins Sans Frontières (MSF), Paris, Sorbonne Université, Institut national de la santé et de la recherche médicale, Unité 1135, Centre d'Immunologie et des Maladies Infectieuses, Paris, Assistance Publique Hôpitaux de Paris (APHP), Groupe Hospitalier Universitaire Sorbonne Université, Hôpital Pitié-Salpêtrière, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries, Paris, France
| | - K L Chew
- Department of Laboratory Medicine, National University Hospital, Singapore City, Singapore
| | - H T Nguyen
- Research Department, Friends for International TB Relief, Ha Noi, Vietnam
| | - C W M Ong
- Infectious Diseases Translational Research Programme, Department of Medicine, National University of Singapore, Singapore City, Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore City, Institute of Healthcare Innovation & Technology, National University of Singapore, Singapore City, Singapore
| | - G Brigden
- The Global Fund, Geneva, Switzerland
| | - K P Singh
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia, Victorian Infectious Disease Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - C Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, German Center for Infection Research (DZIF), TTU-TB, Borstel, Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - J A Seddon
- Department of Infectious Disease, Imperial College London, London, UK, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - B-T Nyang'wa
- Public Health Department, Operational Center Amsterdam (OCA), MSF, Amsterdam, The Netherlands
| | - A K J Maug
- Damien Foundation Bangladesh, Dhaka, Bangladesh
| | - M T Gler
- De La Salle Medical and Health Sciences Institute, Dasmariñas, the Philippines
| | - K E Dooley
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Quelapio
- Tropical Disease Foundation, Makati City, Manila, the Philippines, KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - B Tsogt
- Mongolian Anti-TB Coalition, Ulaanbaatar, Mongolia
| | - D Menzies
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute & McGill International TB Centre, Montreal, QC, Canada
| | - V Cox
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - C M Upton
- TASK Applied Science, Cape Town, South Africa
| | - A Skrahina
- The Republican Scientific and Practical Center for Pulmonology and TB, Minsk, Belarus
| | - L McKenna
- Treatment Action Group, New York, NY
| | - C R Horsburgh
- Departments of Global Health, Epidemiology, Biostatistics and Medicine, Schools of Public Health and Medicine, Boston University, Boston MA, USA
| | - K Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute & South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa, Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
| | - B J Marais
- Sydney Infectious Diseases Institute (Sydney ID), and, The Children's Hospital at Westmead, Sydney, NSW, WHO Collaborating Centre in Tuberculosis, The University of Sydney, Sydney, NSW, Australia
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Patil SB, Tamirat M, Khazhidinov K, Ardizzoni E, Atger M, Austin A, Baudin E, Bekhit M, Bektasov S, Berikova E, Bonnet M, Caboclo R, Chaudhry M, Chavan V, Cloez S, Coit J, Coutisson S, Dakenova Z, De Jong BC, Delifer C, Demaisons S, Do JM, Dos Santos Tozzi D, Ducher V, Ferlazzo G, Gouillou M, Khan U, Kunda M, Lachenal N, LaHood AN, Lecca L, Mazmanian M, McIlleron H, Moreau M, Moschioni M, Nahid P, Osso E, Oyewusi L, Panda S, Pâquet A, Thuong Huu P, Pichon L, Rich ML, Rupasinghe P, Salahuddin N, Sanchez Garavito E, Seung KJ, Velásquez GE, Vallet M, Varaine F, Yuya-Septoh FJ, Mitnick CD, Guglielmetti L. Evaluating newly approved drugs in combination regimens for multidrug-resistant tuberculosis with fluoroquinolone resistance (endTB-Q): study protocol for a multi-country randomized controlled trial. Trials 2023; 24:773. [PMID: 38037119 PMCID: PMC10688049 DOI: 10.1186/s13063-023-07701-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/04/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Treatment for fluoroquinolone-resistant multidrug-resistant/rifampicin-resistant tuberculosis (pre-XDR TB) often lasts longer than treatment for less resistant strains, yields worse efficacy results, and causes substantial toxicity. The newer anti-tuberculosis drugs, bedaquiline and delamanid, and repurposed drugs clofazimine and linezolid, show great promise for combination in shorter, less-toxic, and effective regimens. To date, there has been no randomized, internally and concurrently controlled trial of a shorter, all-oral regimen comprising these newer and repurposed drugs sufficiently powered to produce results for pre-XDR TB patients. METHODS endTB-Q is a phase III, multi-country, randomized, controlled, parallel, open-label clinical trial evaluating the efficacy and safety of a treatment strategy for patients with pre-XDR TB. Study participants are randomized 2:1 to experimental or control arms, respectively. The experimental arm contains bedaquiline, linezolid, clofazimine, and delamanid. The control comprises the contemporaneous WHO standard of care for pre-XDR TB. Experimental arm duration is determined by a composite of smear microscopy and chest radiographic imaging at baseline and re-evaluated at 6 months using sputum culture results: participants with less extensive disease receive 6 months and participants with more extensive disease receive 9 months of treatment. Randomization is stratified by country and by participant extent-of-TB-disease phenotype defined according to screening/baseline characteristics. Study participation lasts up to 104 weeks post randomization. The primary objective is to assess whether the efficacy of experimental regimens at 73 weeks is non-inferior to that of the control. A sample size of 324 participants across 2 arms affords at least 80% power to show the non-inferiority, with a one-sided alpha of 0.025 and a non-inferiority margin of 12%, against the control in both modified intention-to-treat and per-protocol populations. DISCUSSION This internally controlled study of shortened treatment for pre-XDR TB will provide urgently needed data and evidence for clinical and policy decision-making around the treatment of pre-XDR TB with a four-drug, all-oral, shortened regimen. TRIAL REGISTRATION ClinicalTrials.Gov NCT03896685. Registered on 1 April 2018; the record was last updated for study protocol version 4.3 on 17 March 2023.
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Affiliation(s)
- S B Patil
- Indian Council of Medical Research (ICMR) - National AIDS Research Institute, Pune, India
| | | | | | - E Ardizzoni
- Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | - M Atger
- Medical Department, Médecins Sans Frontières, 14-34 Avenue Jean Jaurès, 75019, Paris, France
| | - A Austin
- UCSF Center for Tuberculosis, University of California, , San Francisco, San Francisco, CA, USA
| | | | - M Bekhit
- Medical Department, Médecins Sans Frontières, 14-34 Avenue Jean Jaurès, 75019, Paris, France
| | | | - E Berikova
- Partners In Health, Astana, Kazakhstan
- National Scientific Center of Phthisiopulmonology, Almaty, Kazakhstan
| | - M Bonnet
- Université de Montpellier, IRD, INSERM, Montpellier, TransVIHMI, France
| | - R Caboclo
- Medical Department, Médecins Sans Frontières, 14-34 Avenue Jean Jaurès, 75019, Paris, France
| | - M Chaudhry
- Medical Department, Médecins Sans Frontières, 14-34 Avenue Jean Jaurès, 75019, Paris, France
| | - V Chavan
- Médecins Sans Frontières, Mumbai, India
| | - S Cloez
- Medical Department, Médecins Sans Frontières, 14-34 Avenue Jean Jaurès, 75019, Paris, France
| | - J Coit
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - S Coutisson
- Médecins Sans Frontières, Geneva, Switzerland
| | - Z Dakenova
- City Center of Phthisiopulmonology, Astana, Kazakhstan
| | - B C De Jong
- Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | - C Delifer
- Medical Department, Médecins Sans Frontières, 14-34 Avenue Jean Jaurès, 75019, Paris, France
| | - S Demaisons
- Medical Department, Médecins Sans Frontières, 14-34 Avenue Jean Jaurès, 75019, Paris, France
| | - J M Do
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - V Ducher
- Medical Department, Médecins Sans Frontières, 14-34 Avenue Jean Jaurès, 75019, Paris, France
| | - G Ferlazzo
- Médecins Sans Frontières, Geneva, Switzerland
| | | | - U Khan
- Interactive Research and Development (IRD) Global, Singapore, Singapore
| | - M Kunda
- Partners In Health, Maseru, Lesotho
| | - N Lachenal
- Médecins Sans Frontières, Geneva, Switzerland
| | - A N LaHood
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - L Lecca
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Socios En Salud-Sucursal Peru, Lima, Peru
| | - M Mazmanian
- Medical Department, Médecins Sans Frontières, 14-34 Avenue Jean Jaurès, 75019, Paris, France
- Assistance Publique Hôpitaux de Paris (APHP), Unité de Recherche Clinique, Hôpital Pitié-Salpêtrière, Paris, France
- Santé Arménie French-Armenian Research Center, Yerevan, Armenia
| | - H McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa), Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - M Moreau
- Medical Department, Médecins Sans Frontières, 14-34 Avenue Jean Jaurès, 75019, Paris, France
| | | | - P Nahid
- UCSF Center for Tuberculosis, University of California, , San Francisco, San Francisco, CA, USA
| | - E Osso
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - S Panda
- Indian Council of Medical Research Headquarters, New Delhi, India
- Indian Journal of Medical Research, New Delhi, India
| | - A Pâquet
- Medical Department, Médecins Sans Frontières, 14-34 Avenue Jean Jaurès, 75019, Paris, France
| | | | - L Pichon
- Medical Department, Médecins Sans Frontières, 14-34 Avenue Jean Jaurès, 75019, Paris, France
| | - M L Rich
- Partners In Health, Boston, MA, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - P Rupasinghe
- Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | - N Salahuddin
- Indus Hospital & Health Network, Karachi, Pakistan
| | | | | | - G E Velásquez
- UCSF Center for Tuberculosis, University of California, , San Francisco, San Francisco, CA, USA
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - M Vallet
- Medical Department, Médecins Sans Frontières, 14-34 Avenue Jean Jaurès, 75019, Paris, France
| | - F Varaine
- Medical Department, Médecins Sans Frontières, 14-34 Avenue Jean Jaurès, 75019, Paris, France
| | | | - C D Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Partners In Health, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - L Guglielmetti
- Medical Department, Médecins Sans Frontières, 14-34 Avenue Jean Jaurès, 75019, Paris, France.
- Sorbonne Université, INSERM, U1135, Centre d'Immunologie Et Des Maladies Infectieuses, Paris, France.
- Assistance Publique Hôpitaux de Paris (APHP), Groupe Hospitalier Universitaire Sorbonne Université, Hôpital Pitié Salpêtrière, Centre National De Référence Des Mycobactéries Et De La Résistance Des Mycobactéries Aux Antituberculeux, Paris, France.
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Günther G, Guglielmetti L, Leu C, van Leth F, Lange C. Relative cost of multidrug-resistant TB medicines in Europe. Int J Tuberc Lung Dis 2023; 27:341-344. [PMID: 37143231 DOI: 10.5588/ijtld.23.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Affiliation(s)
- G Günther
- Department of Pulmonary Medicine and Allergology, Inselspital, Bern University Hospital, University of Bern, Switzerland, Department of Medical Sciences, School of Medicine, University of Namibia, Windhoek, Namibia
| | - L Guglielmetti
- Sorbonne Université, Institut national de la santé et de la recherche médicale, U1135, Centre d´Immunologie et des Maladies Infectieuses, Centre d´Immunologie et des Maladies Infectieuses, Paris, France, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Universitaire Sorbonne Université, Hôpital Pitié-Salpêtrière, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Paris, France
| | - C Leu
- Department of Pulmonary Medicine and Allergology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - F van Leth
- Department of Health Sciences, Vrije Universiteit, Amsterdam, The Netherlands, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - C Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany, German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany, Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany, Baylor College of Medicine and Texas Children´s Hospital, Global TB Program, Houston, TX, USA
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Campbell JR, Chan ED, Anderson LF, Bonnet M, Brode SK, Cegielski JP, Guglielmetti L, Singla R, Fox GJ, Skrahina A, Rodrigues D, Kuksa L, Viiklepp P, Menzies D. Association of smoking and alcohol use with rifampin-resistant TB treatment outcomes. Int J Tuberc Lung Dis 2023; 27:338-340. [PMID: 37035974 DOI: 10.5588/ijtld.22.0678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023] Open
Affiliation(s)
- J R Campbell
- Department of Medicine & Department of Global and Public Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada, McGill International TB Centre, Montreal, QC, Canada, Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - E D Chan
- Department of Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA, Department of Academic Affairs, National Jewish Health, Denver, CO, USA, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - L F Anderson
- Strategic Information for Response, Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - M Bonnet
- University of Montpellier, Recherches Translationnelles sur le VIH et les Maladies Infectieuses, Institut de Recherche pour le Developpement, Institut national de la santé et de la recherche médicale (INSERM), Montpellier, France, Epicentre, Paris, France
| | - S K Brode
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON Canada, Department of Medicine, Division of Respirology, University Health Network, Toronto, ON Canada, Department of Medicine, University of Toronto, Toronto, ON Canada
| | - J P Cegielski
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - L Guglielmetti
- Sorbonne Université, Centre d´Immunologie et des Maladies Infectieuses (Cimi-Paris), INSERM, U1135, Paris, France, Assistance Publique Hôpitaux de Paris Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Laboratoire de Bactériologie-Hygiène, Hôpital Pitié-Salpêtrière, Paris, France
| | - R Singla
- Department of TB and Respiratory Diseases, National Institute of TB and Respiratory Diseases, New Delhi, India
| | - G J Fox
- University of Sydney, Sydney, NSW, Australia
| | - A Skrahina
- Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | - D Rodrigues
- Instituto Clemente Ferreira, São Paulo, SP, Brazil
| | - L Kuksa
- Department of MDR TB, Riga East University Hospital, Riga, Latvia
| | - P Viiklepp
- Department of Registries, National Institute for Health Development, Tallinn, Estonia
| | - D Menzies
- McGill International TB Centre, Montreal, QC, Canada, Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada, Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
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Khan U, Guglielmetti L. Tailored TPT for drug-resistant TB - promoting equity and access to optimal care. Int J Tuberc Lung Dis 2023; 27:89b-90. [PMID: 36853142 DOI: 10.5588/ijtld.22.0538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- U Khan
- Interactive Research & Development Global, Singapore City, Singapore
| | - L Guglielmetti
- Unité 1135, Centre d´Immunologie et des Maladies Infectieuses Paris, Institut national de la santé et de la recherche médicale, Sorbonne Université, Paris, France, Hôpital Pitié-Salpêtrière, Groupe Hospitalier Universitaire Sorbonne Université, Assistance publique Hôpitaux de Paris, Centre national de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Paris, France
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Khan U, Guglielmetti L. Evidence and ethical considerations for the treatment of contacts exposed to drug-resistant TB. Int J Tuberc Lung Dis 2022; 26:900-901. [PMID: 35996292 DOI: 10.5588/ijtld.22.0328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- U Khan
- Interactive Research & Development Global, Singapore, Singapore
| | - L Guglielmetti
- Sorbonne Université, Institut national de la santé et de la recherche médicale, Unité 1135, Centre d´Immunologie et des Maladies Infectieuses, Centre of Immunology and Microbial Infections-Paris, Paris, France, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Universitaire Sorbonne Université, Hôpital Pitié-Salpêtrière, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Paris, France
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Guglielmetti L, Ardizzoni E, Atger M, Baudin E, Berikova E, Bonnet M, Chang E, Cloez S, Coit JM, Cox V, de Jong BC, Delifer C, Do JM, Tozzi DDS, Ducher V, Ferlazzo G, Gouillou M, Khan A, Khan U, Lachenal N, LaHood AN, Lecca L, Mazmanian M, McIlleron H, Moschioni M, O’Brien K, Okunbor O, Oyewusi L, Panda S, Patil SB, Phillips PPJ, Pichon L, Rupasinghe P, Rich ML, Saluhuddin N, Seung KJ, Tamirat M, Trippa L, Cellamare M, Velásquez GE, Wasserman S, Zimetbaum PJ, Varaine F, Mitnick CD. Evaluating newly approved drugs for multidrug-resistant tuberculosis (endTB): study protocol for an adaptive, multi-country randomized controlled trial. Trials 2021; 22:651. [PMID: 34563240 PMCID: PMC8465691 DOI: 10.1186/s13063-021-05491-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment of multidrug- and rifampin-resistant tuberculosis (MDR/RR-TB) is expensive, labour-intensive, and associated with substantial adverse events and poor outcomes. While most MDR/RR-TB patients do not receive treatment, many who do are treated for 18 months or more. A shorter all-oral regimen is currently recommended for only a sub-set of MDR/RR-TB. Its use is only conditionally recommended because of very low-quality evidence underpinning the recommendation. Novel combinations of newer and repurposed drugs bring hope in the fight against MDR/RR-TB, but their use has not been optimized in all-oral, shorter regimens. This has greatly limited their impact on the burden of disease. There is, therefore, dire need for high-quality evidence on the performance of new, shortened, injectable-sparing regimens for MDR-TB which can be adapted to individual patients and different settings. METHODS endTB is a phase III, pragmatic, multi-country, adaptive, randomized, controlled, parallel, open-label clinical trial evaluating the efficacy and safety of shorter treatment regimens containing new drugs for patients with fluoroquinolone-susceptible, rifampin-resistant tuberculosis. Study participants are randomized to either the control arm, based on the current standard of care for MDR/RR-TB, or to one of five 39-week multi-drug regimens containing newly approved and repurposed drugs. Study participation in all arms lasts at least 73 and up to 104 weeks post-randomization. Randomization is response-adapted using interim Bayesian analysis of efficacy endpoints. The primary objective is to assess whether the efficacy of experimental regimens at 73 weeks is non-inferior to that of the control. A sample size of 750 patients across 6 arms affords at least 80% power to detect the non-inferiority of at least 1 (and up to 3) experimental regimens, with a one-sided alpha of 0.025 and a non-inferiority margin of 12%, against the control in both modified intention-to-treat and per protocol populations. DISCUSSION The lack of a safe and effective regimen that can be used in all patients is a major obstacle to delivering appropriate treatment to all patients with active MDR/RR-TB. Identifying multiple shorter, safe, and effective regimens has the potential to greatly reduce the burden of this deadly disease worldwide. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02754765. Registered on 28 April 2016; the record was last updated for study protocol version 3.3, on 27 August 2019.
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Affiliation(s)
- L. Guglielmetti
- Médecins Sans Frontières, Paris, France
- Sorbonne Université, INSERM, U1135, Centre d’Immunologie Et Des Maladies Infectieuses, Paris, France
- Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Universitaire Sorbonne Université, Hôpital Pitié-Salpêtrière, Centre National De Référence Des Mycobactéries Et De La Résistance Des Mycobactéries Aux Antituberculeux, Paris, France
| | - E. Ardizzoni
- Institute of Tropical Medicine, Antwerp, Belgium
| | - M. Atger
- Médecins Sans Frontières, Paris, France
| | | | - E. Berikova
- Partners In Health, Astana, Kazakhstan
- National Scientific Center of Phthisiopulmonology, Almaty, Kazakhstan
| | - M. Bonnet
- Médecins Sans Frontières, Paris, France
- Institut de Recherche pour le Développement/INSERM U1175/UMI233/ Université de Montpellier, Montpellier, France
| | - E. Chang
- Médecins Sans Frontières, Toronto, Ontario Canada
| | - S. Cloez
- Médecins Sans Frontières, Paris, France
| | - J. M. Coit
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | - V. Cox
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | | | - J. M. Do
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | | | - V. Ducher
- Médecins Sans Frontières, Paris, France
| | - G. Ferlazzo
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | | | - A. Khan
- Interactive Research and Development, Karachi, Pakistan
| | - U. Khan
- Interactive Research and Development, Karachi, Pakistan
| | | | - A. N. LaHood
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | - L. Lecca
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
- Socios En Salud-Sucursal Peru, Lima, Peru
| | - M. Mazmanian
- Médecins Sans Frontières, Paris, France
- Assistance Publique Hôpitaux de Paris, Unité de Recherche Clinique, Hôpital Pitié-Salpêtrière, Paris, France
| | - H. McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | | | | | - O. Okunbor
- Social & Scientific Systems-DLH, Silver Spring, MD USA
| | | | - S. Panda
- Epidemiology and Communicable Diseases Division, Indian Council of Medical Research, Pune, India
- Indian Council of Medical Research – National AIDS Research Institute, Pune, India
| | - S. B. Patil
- Indian Council of Medical Research – National AIDS Research Institute, Pune, India
| | - P. P. J. Phillips
- University of San Francisco Center for Tuberculosis, San Francisco, CA USA
| | - L. Pichon
- Médecins Sans Frontières, Paris, France
| | | | - M. L. Rich
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
- Partners In Health, Boston, MA USA
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA
| | - N. Saluhuddin
- Department of Infectious Diseases, Indus Hospital, Karachi, Pakistan
| | - K. J. Seung
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
- Partners In Health, Boston, MA USA
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA
| | | | - L. Trippa
- Dana-Farber Cancer Institute, Boston, MA USA
- Harvard T.H. Chan School of Public Health, Boston, MA USA
| | | | - G. E. Velásquez
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA USA
| | - S. Wasserman
- Wellcome Centre for Infectious Diseases Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - P. J. Zimetbaum
- Harvard Medical School, Boston, MA USA
- Beth Israel Deaconess Medical Center, Boston, MA USA
| | | | - C. D. Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
- Partners In Health, Boston, MA USA
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA
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Starshinova A, Guglielmetti L, Rzhepishevska O, Ekaterincheva O, Zinchenko Y, Kudlay D. Diagnostics and management of tuberculosis and COVID-19 in a patient with pneumothorax (clinical case). J Clin Tuberc Other Mycobact Dis 2021; 24:100259. [PMID: 34235277 PMCID: PMC8245665 DOI: 10.1016/j.jctube.2021.100259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The spread of COVID-19 in countries with high and medium incidence of tuberculosis has led to an increased risk of COVID-19 and tuberculosis co-infection, introducing new diagnostic and therapeutic challenges for the clinician. Hereby we describe a first case where tuberculosis and COVID-19 were diagnosed concomitantly in a Russian patient with pneumothorax. We discuss the challenges associated with the diagnosis and treatment of tuberculosis during the COVID-19 pandemic.
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Affiliation(s)
- A Starshinova
- Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - L Guglielmetti
- APHP, Groupe Hospitalier Universitaire Sorbonne Université, Hôpital Pitié-Salpêtrière, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, F-75013 Paris, France.,Sorbonne Université, INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses, Cimi-Paris, équipe 2, F-75013 Paris, France
| | | | - O Ekaterincheva
- St. Petersburg Tuberculosis Hospital No. 2, Saint Petersburg, Russia
| | - Yu Zinchenko
- St. Petersburg Research Institute of Phthisiopulmonology, Russia
| | - D Kudlay
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,NRC Institute of Immunology FMBA of Russia, Moscow, Russia
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Nyang'wa BT, LaHood AN, Mitnick CD, Guglielmetti L. TB research requires strong protections, innovation, and increased funding in response to COVID-19. Trials 2021; 22:371. [PMID: 34051826 PMCID: PMC8164060 DOI: 10.1186/s13063-021-05331-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/18/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- B T Nyang'wa
- Manson Unit, Médecins Sans Frontières, London, UK
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - A N LaHood
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - C D Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, 02115, USA.
- Partners In Health, Boston, MA, USA.
| | - L Guglielmetti
- Médecins Sans Frontières, Paris, France
- Sorbonne Université, INSERM, U1135, Centre d'Immunologie Et Des Maladies Infectieuses, Paris, France
- APHP, Groupe Hospitalier Universitaire Sorbonne Université, Hôpital Pitié-Salpêtrière, Centre National De Référence Des Mycobactéries Et De La Résistance Des Mycobactéries Aux Antituberculeux, Paris, France
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10
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Cox V, McKenna L, Acquah R, Reuter A, Wasserman S, Vambe D, Ustero P, Udwadia Z, Triviño-Duran L, Tommasi M, Skrahina A, Seddon JA, Rodolfo R, Rich M, Padanilam X, Oyewusi L, Ohler L, Lungu P, Loveday M, Khan U, Khan P, Hughes J, Hewison C, Guglielmetti L, Furin J. Clinical perspectives on treatment of rifampicin-resistant/multidrug-resistant TB. Int J Tuberc Lung Dis 2021; 24:1134-1144. [PMID: 33172520 DOI: 10.5588/ijtld.20.0330] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Rapid diagnostics, newer drugs, repurposed medications, and shorter regimens have radically altered the landscape for treating rifampicin-resistant TB (RR-TB) and multidrug-resistant TB (MDR-TB). There are multiple ongoing clinical trials aiming to build a robust evidence base to guide RR/MDR-TB treatment, and both observational studies and programmatic data have contributed to advancing the treatment field. In December 2019, the WHO issued their second 'Rapid Communication´ related to RR-TB management. This reiterated their prior recommendation that a majority of people with RR/MDR-TB receive all-oral treatment regimens, and now allow for specific shorter duration regimens to be used programmatically as well. Many TB programs need clinical advice as they seek to roll out such regimens in their specific setting. In this Perspective, we highlight our early experiences and lessons learned from working with National TB Programs, adult and pediatric clinicians and civil society, in optimizing treatment of RR/MDR-TB, using shorter, highly-effective, oral regimens for the majority of people with RR/MDR-TB.
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Affiliation(s)
- V Cox
- Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, Soauth Africa
| | - L McKenna
- Treatment Action Group, New York, NY, USA
| | - R Acquah
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - A Reuter
- Médecins Sans Frontières (MSF), Khayelitsha, South Africa
| | - S Wasserman
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, and Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - D Vambe
- Eswatini National TB Control Programme, Manzini, Eswatini
| | - P Ustero
- Global TB Program, Baylor College of Medicine, Houston, TX, USA
| | - Z Udwadia
- Hinduja Hospital & Research Centre, Mumbai, India
| | | | - M Tommasi
- Independent Consultant, Maputo, Mozambique
| | - A Skrahina
- Republican Scientific and Practical Centre for Pulmonology and TB, Minsk, Belarus
| | - J A Seddon
- Department of Infectious Diseases, Imperial College London, UK, and Desmond Tutu TB Centre, Department of Paediatrics and Child Health, University of Stellenbosch, Tygerberg, South Africa
| | - R Rodolfo
- National Department of Health, Mahikeng, North West Province, South Africa
| | - M Rich
- Partners In Health (PIH), Boston, MA, USA
| | - X Padanilam
- National Department of Health, Johannesburg, Gauteng Province, South Africa
| | | | | | - P Lungu
- National Tuberculosis and Leprosy Programme, Ministry of Health, Lusaka, Zambia
| | - M Loveday
- Health Systems Research Unit, South African Medical Research Council, Durban, South Africa
| | - U Khan
- Interactive Research and Development, Karachi
| | - P Khan
- Interactive Research and Development, Karachi, Pakistan, and Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - J Hughes
- Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | | | | | - J Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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11
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Cox V, Guglielmetti L, Hewison C, Reuter A, Furin J. Reply to: "Human rights: finding the right balance for rifampicin-resistant TB treatment". Int J Tuberc Lung Dis 2021; 25:328-329. [PMID: 33762080 DOI: 10.5588/ijtld.21.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- V Cox
- Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | | | - A Reuter
- Médecins Sans Frontières, South Africa
| | - J Furin
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA, USA ,
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12
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Molina-Moya B, Guglielmetti L, Bothamley G, van Leth F, Lange C, Dominguez J. Use and impact of molecular methods for detecting drug-resistant TB. Int J Tuberc Lung Dis 2021; 25:157-159. [PMID: 33656431 DOI: 10.5588/ijtld.20.0527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- B Molina-Moya
- Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBER Enfermedades Respiratorias (CIBERES), Badalona, Spain
| | - L Guglielmetti
- Unité 1135, Institut National de la Santé et de la Recherche Médicale, Centre d'Immunologie et des Maladies Infectieuses, Sorbonne Université, Paris, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpital Pitié-Salpêtrière, Groupe Hospitalier Universitaire Sorbonne Université, Assistanve Publique-Hôpitaux de Paris, Paris, France
| | - G Bothamley
- Department of Respiratory Medicine, Homerton University Hospital, Queen Mary University, London, London School of Hygiene & Tropical Medicine, London, UK
| | - F van Leth
- Department of Global Health, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
| | - C Lange
- Divisions of Clinical Infectious Diseases, Research Center Borstel, German Center for Infection Research (DZIF), Clinical Tuberculosis Unit, Borstel, Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany
| | - J Dominguez
- Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBER Enfermedades Respiratorias (CIBERES), Badalona, Spain
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13
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Tunesi S, Guglielmetti L, Bachir M, Le Dû D, Marigot-Outtandy D, Robert J, Fréchet-Jachym M. Tuberculose résistante à l’isoniazide : expérience d’un centre de référence français. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Guglielmetti L, Jaffré J, Bernard C, Brossier F, El Helali N, Chadelat K, Thouvenin G, Dautzenberg B, Henry B, Jaspard M, Guillot H, Pourcher V, Le Dû D, Marigot-Outtandy D, Mougari F, Raskine L, Rivoire B, Andrejak C, Jarlier V, Aubry A, Robert J, Frechet-Jachym M, Veziris N. Multidisciplinary advisory teams to manage multidrug-resistant tuberculosis: the example of the French Consilium. Int J Tuberc Lung Dis 2020; 23:1050-1054. [PMID: 31627768 DOI: 10.5588/ijtld.18.0779] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: The World Health Organization (WHO) recommends that multidrug-resistant tuberculosis (MDR-TB) treatment should be managed in collaboration with multidisciplinary advisory committees (consilia). A formal national Consilium has been established in France since 2005 to provide a centralised advisory service for clinicians managing MDR-TB and extensively drug-resistant (XDR-TB) cases.OBJECTIVE: Review the activity of the French TB Consilium since its establishment.DESIGN: Retrospective description and analysis of the activity of the French TB Consilium.RESULTS: Between 2005 and 2016, 786 TB cases or contacts of TB cases were presented at the French TB Consilium, including respectively 42% and 79% of all the MDR-TB and XDR-TB cases notified in France during this period. Treatment regimens including bedaquiline and/or delamanid were recommended for 42% of the cases presented at the French TB Consilium since 2009. Patients were more likely to be presented at the French TB Consilium if they were born in the WHO Europe Region, had XDR-TB, were diagnosed in the Paris region, or had resistance to additional drugs than those defining XDR-TB.CONCLUSION: The French TB Consilium helped supervise appropriate management of MDR/XDR-TB cases and facilitated implementation of new drugs for MDR/XDR-TB treatment.
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Affiliation(s)
- L Guglielmetti
- Sorbonne Université, Centre d'immunologie et des Maladies Infectieuses-Paris (CIMI-Paris), Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Laboratoire de Bactériologie-Hygiène, Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris
| | - J Jaffré
- Sorbonne Université, Centre d'immunologie et des Maladies Infectieuses-Paris (CIMI-Paris), Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Laboratoire de Bactériologie-Hygiène, Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris
| | - C Bernard
- Service de Biologie, Grand Hôpital de l'Est Francilien, Jossigny
| | - F Brossier
- Sorbonne Université, Centre d'immunologie et des Maladies Infectieuses-Paris (CIMI-Paris), Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Laboratoire de Bactériologie-Hygiène, Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris
| | - N El Helali
- Plateforme de dosages des anti-infectieux, Groupe Hospitalier Paris Saint-Joseph, Paris
| | - K Chadelat
- APHP, Hôpital d'enfants Armand-Trousseau, Paris
| | - G Thouvenin
- APHP, Hôpital d'enfants Armand-Trousseau, Paris
| | - B Dautzenberg
- APHP, Pneumologie, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris
| | - B Henry
- Sorbonne Université, CIMI-Paris, APHP, Service des Maladies Infectieuses et Tropicales, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Paris
| | - M Jaspard
- Sorbonne Université, CIMI-Paris, APHP, Service des Maladies Infectieuses et Tropicales, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Paris
| | - H Guillot
- Sorbonne Université, CIMI-Paris, APHP, Service des Maladies Infectieuses et Tropicales, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Paris
| | - V Pourcher
- Sorbonne Université, CIMI-Paris, APHP, Service des Maladies Infectieuses et Tropicales, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Paris
| | - D Le Dû
- Sanatorium, Centre Hospitalier de Bligny, Briis-sous-Forges
| | - D Marigot-Outtandy
- Sanatorium, Centre Hospitalier de Bligny, Briis-sous-Forges, APHP, Service de Médecine Aigue Spécialisée, Hôpital Raymond Poincaré, Garches
| | - F Mougari
- APHP, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Bactériologie-Virologie, Hôpitaux Universitaires Lariboisière-St Louis-Widal, Paris
| | - L Raskine
- APHP, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Bactériologie-Virologie, Hôpitaux Universitaires Lariboisière-St Louis-Widal, Paris
| | - B Rivoire
- Service d'Aide Médicale Urgente Social, Paris
| | - C Andrejak
- Pneumologie, Centre Hospitalière Universitaire d'Amiens, Amiens
| | - V Jarlier
- Sorbonne Université, Centre d'immunologie et des Maladies Infectieuses-Paris (CIMI-Paris), Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Laboratoire de Bactériologie-Hygiène, Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris
| | - A Aubry
- Sorbonne Université, Centre d'immunologie et des Maladies Infectieuses-Paris (CIMI-Paris), Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Laboratoire de Bactériologie-Hygiène, Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris
| | - J Robert
- Sorbonne Université, Centre d'immunologie et des Maladies Infectieuses-Paris (CIMI-Paris), Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Laboratoire de Bactériologie-Hygiène, Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris
| | | | - N Veziris
- Sorbonne Université, CIMI-Paris, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Département de Bactériologie, APHP, Hôpitaux Universitaires de l'Est Parisien, F-75012 Paris, France
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15
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Guglielmetti L, Veziris N, Aubry A, Brossier F, Bernard C, Sougakoff W, Jarlier V, Robert J. Risk factors for extensive drug resistance in multidrug-resistant tuberculosis cases: a case-case study. Int J Tuberc Lung Dis 2019; 22:54-59. [PMID: 29297426 DOI: 10.5588/ijtld.17.0387] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTINGS Identification of extensively drug-resistant tuberculosis (XDR-TB) may be delayed because of the lack of availability of molecular testing for second-line drugs (SLDs). Early suspicion of XDR-TB is therefore necessary to avoid developing further drug resistance. OBJECTIVE To identify the characteristics associated with XDR-TB among multidrug-resistant TB (MDR-TB) cases before the availability of second-line drug susceptibility testing (DST) results. METHODS All MDR-TB cases with available second-line DST results recorded in France from 1998 to 2013 were classified as simple MDR-TB (no resistance to fluoroquinolones [FQs] or second-line injectable drugs [SLIDs]), pre-XDR-TB (resistance to FQs or SLIDs) and XDR-TB cases (resistance to both). RESULTS A total of 833 MDR-TB cases were analysed, including 168 (20%) pre-XDR and 62 (7%) XDR-TB cases. A previous history of treatment was acknowledged among 41% of the cases; 12% were human immunodeficiency virus-positive. Characteristics independently associated with XDR-TB were foreign birth (OR 9.5), previous anti-tuberculosis treatment (OR 2.6), smear positivity (OR 4.5) and ethambutol (EMB) resistance (OR 9.1). Characteristics independently associated with pre-XDR-TB compared to simple MDR-TB cases were male sex (OR 1.6), birth in Europe (OR 2.6) and EMB resistance (OR 1.9). CONCLUSION The presence of clinical or bacteriological characteristics associated with XDR-TB should lead to rapid molecular testing for resistance to SLDs before starting tailored treatment.
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Affiliation(s)
- L Guglielmetti
- Sorbonne University, Faculté de Médecine Pierre et Marie Curie, Université Paris 06, Centre d'Immunologie et des Maladies Infectieuses, Paris, Assistance Publique-Hôpitaux de Paris, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Bactériologie-Hygiène, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Paris, France
| | - N Veziris
- Sorbonne University, Faculté de Médecine Pierre et Marie Curie, Université Paris 06, Centre d'Immunologie et des Maladies Infectieuses, Paris, Assistance Publique-Hôpitaux de Paris, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Bactériologie-Hygiène, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Paris, France
| | - A Aubry
- Sorbonne University, Faculté de Médecine Pierre et Marie Curie, Université Paris 06, Centre d'Immunologie et des Maladies Infectieuses, Paris, Assistance Publique-Hôpitaux de Paris, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Bactériologie-Hygiène, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Paris, France
| | - F Brossier
- Sorbonne University, Faculté de Médecine Pierre et Marie Curie, Université Paris 06, Centre d'Immunologie et des Maladies Infectieuses, Paris, Assistance Publique-Hôpitaux de Paris, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Bactériologie-Hygiène, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Paris, France
| | - C Bernard
- Sorbonne University, Faculté de Médecine Pierre et Marie Curie, Université Paris 06, Centre d'Immunologie et des Maladies Infectieuses, Paris, Assistance Publique-Hôpitaux de Paris, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Bactériologie-Hygiène, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Paris, France
| | - W Sougakoff
- Sorbonne University, Faculté de Médecine Pierre et Marie Curie, Université Paris 06, Centre d'Immunologie et des Maladies Infectieuses, Paris, Assistance Publique-Hôpitaux de Paris, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Bactériologie-Hygiène, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Paris, France
| | - V Jarlier
- Sorbonne University, Faculté de Médecine Pierre et Marie Curie, Université Paris 06, Centre d'Immunologie et des Maladies Infectieuses, Paris, Assistance Publique-Hôpitaux de Paris, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Bactériologie-Hygiène, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Paris, France
| | - J Robert
- Sorbonne University, Faculté de Médecine Pierre et Marie Curie, Université Paris 06, Centre d'Immunologie et des Maladies Infectieuses, Paris, Assistance Publique-Hôpitaux de Paris, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Bactériologie-Hygiène, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Paris, France
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Lange C, Aarnoutse RE, Alffenaar JWC, Bothamley G, Brinkmann F, Costa J, Chesov D, van Crevel R, Dedicoat M, Dominguez J, Duarte R, Grobbel HP, Günther G, Guglielmetti L, Heyckendorf J, Kay AW, Kirakosyan O, Kirk O, Koczulla RA, Kudriashov GG, Kuksa L, van Leth F, Magis-Escurra C, Mandalakas AM, Molina-Moya B, Peloquin CA, Reimann M, Rumetshofer R, Schaaf HS, Schön T, Tiberi S, Valda J, Yablonskii PK, Dheda K. Management of patients with multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2019; 23:645-662. [DOI: 10.5588/ijtld.18.0622] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- C. Lange
- Please see Supplementary Data for details of all author affiliations
| | - R. E. Aarnoutse
- Please see Supplementary Data for details of all author affiliations
| | | | - G. Bothamley
- Please see Supplementary Data for details of all author affiliations
| | - F. Brinkmann
- Please see Supplementary Data for details of all author affiliations
| | - J. Costa
- Please see Supplementary Data for details of all author affiliations
| | - D. Chesov
- Please see Supplementary Data for details of all author affiliations
| | - R. van Crevel
- Please see Supplementary Data for details of all author affiliations
| | - M. Dedicoat
- Please see Supplementary Data for details of all author affiliations
| | - J. Dominguez
- Please see Supplementary Data for details of all author affiliations
| | - R. Duarte
- Please see Supplementary Data for details of all author affiliations
| | - H. P. Grobbel
- Please see Supplementary Data for details of all author affiliations
| | - G. Günther
- Please see Supplementary Data for details of all author affiliations
| | - L. Guglielmetti
- Please see Supplementary Data for details of all author affiliations
| | - J. Heyckendorf
- Please see Supplementary Data for details of all author affiliations
| | - A. W. Kay
- Please see Supplementary Data for details of all author affiliations
| | - O. Kirakosyan
- Please see Supplementary Data for details of all author affiliations
| | - O. Kirk
- Please see Supplementary Data for details of all author affiliations
| | - R. A. Koczulla
- Please see Supplementary Data for details of all author affiliations
| | - G. G. Kudriashov
- Please see Supplementary Data for details of all author affiliations
| | - L. Kuksa
- Please see Supplementary Data for details of all author affiliations
| | - F. van Leth
- Please see Supplementary Data for details of all author affiliations
| | - C. Magis-Escurra
- Please see Supplementary Data for details of all author affiliations
| | - A. M. Mandalakas
- Please see Supplementary Data for details of all author affiliations
| | - B. Molina-Moya
- Please see Supplementary Data for details of all author affiliations
| | - C. A. Peloquin
- Please see Supplementary Data for details of all author affiliations
| | - M. Reimann
- Please see Supplementary Data for details of all author affiliations
| | - R. Rumetshofer
- Please see Supplementary Data for details of all author affiliations
| | - H. S. Schaaf
- Please see Supplementary Data for details of all author affiliations
| | - T. Schön
- Please see Supplementary Data for details of all author affiliations
| | - S. Tiberi
- Please see Supplementary Data for details of all author affiliations
| | - J. Valda
- Please see Supplementary Data for details of all author affiliations
| | - P. K. Yablonskii
- Please see Supplementary Data for details of all author affiliations
| | - K. Dheda
- Please see Supplementary Data for details of all author affiliations
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Rodriguez CA, Brooks MB, Guglielmetti L, Hewison C, Jachym MF, Lessem E, Varaine F, Mitnick CD. Barriers and facilitators to early access of bedaquiline and delamanid for MDR-TB: a mixed-methods study. Public Health Action 2019; 9:32-41. [DOI: 10.5588/pha.18.0078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/16/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- C. A. Rodriguez
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - M. B. Brooks
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - M. F. Jachym
- Sanatorium, Centre Hospitalier de Bligny, Briissous-Forges, France
| | - E. Lessem
- Treatment Action Group, New York, New York, USA
| | | | - C. D. Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Guglielmetti L, Hewison C, Avaliani Z, Hughes J, Kiria N, Lomtadze N, Ndjeka N, Setkina S, Shabangu A, Sikhondze W, Skrahina A, Veziris N, Furin J. Examples of bedaquiline introduction for the management of multidrug-resistant tuberculosis in five countries. Int J Tuberc Lung Dis 2018; 21:167-174. [PMID: 28234080 DOI: 10.5588/ijtld.16.0493] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For the first time in almost 50 years, there are new drugs available for the treatment of tuberculosis (TB), including bedaquiline (BDQ) and delamanid (DLM). The rate of introduction, however, has not kept pace with patient needs. It is estimated that as many as 23% of multidrug-resistant TB (MDR-TB) patients have an indication for receiving BDQ. As this is the first time the MDR-TB community is introducing new medications, it is important to understand how implementation can be developed in a variety of settings. METHODS A qualitative assessment of country TB programs in which more than 5% of MDR-TB patients were started on BDQ under program conditions. RESULTS National TB programs in Belarus, France, Georgia, South Africa, and Swaziland all started sizeable cohorts of patients on BDQ in 2015. Common factors observed in these programs included experience with compassionate use/expanded access, support from implementing partners, and adequate national or donor-supported budgets. Barriers to introduction included restriction of BDQ to the in-patient setting, lack of access to companion drugs, and the development of systems for pharmacovigilance. CONCLUSION The five countries in this paper are examples of the introduction of new therapeutic options for the treatment of TB.
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Affiliation(s)
- L Guglielmetti
- Sanatorium, Centre Hospitalier de Bligny, Briis-sous-Forges, France; Médecins Sans Frontières, Paris, France; Sorbonne Université, Université Pierre et Marie Curie 06, Unité 1135, Team E13 (Bactériologie), CR7 Institut National de la Santé et de la Recherche Médicale, Centre d'Immunologie et des Maladies Infectieuses, Paris, France
| | - C Hewison
- Médecins Sans Frontières, Paris, France
| | - Z Avaliani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - J Hughes
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - N Kiria
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - N Lomtadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - N Ndjeka
- National Department of Health, Pretoria, South Africa
| | - S Setkina
- Center for Examinations and Tests in Health Service, Republican Unitary Enterprise, Minsk, Republic of Belarus
| | - A Shabangu
- National TB Referral Hospital, Manzini, Swaziland
| | - W Sikhondze
- National Tuberculosis Control Programme, Manzini, Swaziland
| | - A Skrahina
- Republican Scientific and Practical Centre for Pulmonology and TB, Minsk, Belarus
| | - N Veziris
- Sorbonne Université, Université Pierre et Marie Curie 06, Unité 1135, Team E13 (Bactériologie), CR7 Institut National de la Santé et de la Recherche Médicale, Centre d'Immunologie et des Maladies Infectieuses, Paris, France; Assistance Publique Hôpitaux de Paris, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Bactériologie-Hygiène, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France
| | - J Furin
- Harvard Medical School, Boston, Massachusetts, USA
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D'Ambrosio L, Bothamley G, Caminero Luna JA, Duarte R, Guglielmetti L, Muñoz Torrico M, Payen MC, Saavedra Herrera N, Salazar Lezama MA, Skrahina A, Tadolini M, Tiberi S, Veziris N, Migliori GB. Team approach to manage difficult-to-treat TB cases: Experiences in Europe and beyond. Pulmonology 2017; 24:132-141. [PMID: 29229274 DOI: 10.1016/j.rppnen.2017.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/29/2017] [Indexed: 01/17/2023] Open
Abstract
As recommended by the World Health Organization (WHO), optimal management of MDR-TB cases can be ensured by a multi-speciality consultation body known as 'TB Consilium'. This body usually includes different medical specialities, competences and perspectives (e.g., clinical expertise both for adults and children; surgical, radiological and public health expertise; psychological background and nursing experience, among others), thus lowering the risk of making mistakes - or managing the patients inappropriately, in order to improve their clinical outcomes. At present, several high MDR-TB burden countries in the different WHO regions (and beyond) have introduced TB Consilium-like bodies at the national or subnational level to reach consensus on the best treatment approach for their patients affected by TB. In addition, in countries/settings where a formal system of consultation does not exist, specialized staff from MDR-TB reference centres or international organizations usually spend a considerable amount of their working time responding to phone or e-mail clinical queries on how to manage M/XDR-TB cases. The aim of this manuscript is to describe the different experiences with the TB Consilia both at the international level (European Respiratory Society - ERS/WHO TB Consilium) and in some of the countries where this experience operates successfully in Europe and beyond. The Consilium experiences are described around the following topics: (1) history, aims and focus; (2) management and funding; (3) technical functioning and structure; (4) results achieved. In addition a comparative analysis of the TB Consilia in the different countries has been performed.
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Affiliation(s)
- L D'Ambrosio
- WHO Collaborating Centre for TB and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy; Public Health Consulting Group, Lugano, Switzerland.
| | - G Bothamley
- Homerton University Hospital, London, United Kingdom.
| | - J A Caminero Luna
- Pneumology Department, Hospital General de Gran Canaria "Dr. Negrin", Las Palmas de Gran Canaria, Spain; MDR-TB Unit, Tuberculosis Division, International Union against Tuberculosis and Lung Disease The Union, Paris, France.
| | - R Duarte
- National Reference Centre for MDR-TB, Hospital Centre Vila Nova de Gaia, Department of Pneumology, Public Health Science and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - L Guglielmetti
- Sorbonne Universités, UPMC Univ Paris 06, CR7, INSERM U1135, Centre d'Immunologie et des Maladies Infectieuses, CIMI, F-75013 Paris, France; AP-HP, Hôpitaux Universitaires de l'Est Parisien, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, F-75013 Paris, France.
| | - M Muñoz Torrico
- Tuberculosis Clinic, National Institute of Respiratory Diseases of Mexico (INER), Mexico City, Mexico.
| | - M C Payen
- Division of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles ULB, Brussels, Belgium.
| | | | - M A Salazar Lezama
- Tuberculosis Clinic, National Institute of Respiratory Diseases of Mexico (INER), Mexico City, Mexico.
| | - A Skrahina
- Republican Research and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus.
| | - M Tadolini
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy.
| | - S Tiberi
- Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom; Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, United Kingdom.
| | - N Veziris
- Sorbonne Universités, UPMC Univ Paris 06, CR7, INSERM U1135, Centre d'Immunologie et des Maladies Infectieuses, CIMI, F-75013 Paris, France; AP-HP, Hôpitaux Universitaires de l'Est Parisien, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, F-75013 Paris, France
| | - G B Migliori
- WHO Collaborating Centre for TB and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italy.
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Ratti P, Faraci F, Hackethal S, Pereno M, Ferlito C, Mascheroni A, Caverzasio S, Bonoli S, Guglielmetti L, Amato N, Puiatti A, Kaelin-Lang A. Bedtime to morning variation of mobility after nocturnal sleep in Parkinson's disease. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dheda K, Chang KC, Guglielmetti L, Furin J, Schaaf HS, Chesov D, Esmail A, Lange C. Clinical management of adults and children with multidrug-resistant and extensively drug-resistant tuberculosis. Clin Microbiol Infect 2016; 23:131-140. [PMID: 27756712 DOI: 10.1016/j.cmi.2016.10.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/06/2016] [Accepted: 10/07/2016] [Indexed: 01/29/2023]
Abstract
BACKGROUND Globally there is a burgeoning epidemic of drug monoresistant tuberculosis (TB), multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB). Almost 20% of all TB strains worldwide are resistant to at least one major TB drug, including isoniazid. In several parts of the world there is an increasing incidence of MDR-TB, and alarmingly, almost a third of MDR-TB cases globally are resistant to either a fluoroquinolone or aminoglycoside. This trend cannot be ignored because drug-resistant TB is associated with greater morbidity compared to drug-susceptible TB, accounts for almost 25% of global TB mortality, is extremely costly to treat, consumes substantial portions of budgets allocated to national TB programmes in TB-endemic countries and is a major threat to healthcare workers, who are already in short supply in resource-poor settings. Even more worrying is the growing epidemic of resistance beyond XDR-TB, including resistance to newer drugs such as bedaquiline and delamanid, as well as the increasing prevalence of programmatically incurable TB in countries like South Africa, Russia, India and China. These developments threaten to reverse the gains already made against TB. SOURCES Articles related to MDR-TB and XDR-TB found on PubMed in all languages up to September 2016, published reviews, and files of the authors. AIM AND CONTENT To review the clinical management of adults and children with MDR- and XDR-TB with a particular emphasis on the utility of newer and repurposed drugs such as linezolid, bedaquiline and delamanid, as well as management of MDR- and XDR-TB in special situations such as in HIV-infected persons and in children. IMPLICATIONS This review informs on the prevention, diagnosis, and clinical management of MDR-TB and XDR-TB.
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Affiliation(s)
- K Dheda
- Lung Infection and Immunity Unit, Department of Medicine, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Groote Schuur Hospital, Observatory, South Africa.
| | - K C Chang
- Tuberculosis and Chest Service, Centre for Health Protection, Department of Health, Hong Kong, China
| | - L Guglielmetti
- Sanatorium, Centre Hospitalier de Bligny, Briis-sous-Forges, France; Sorbonne Université, Université Pierre et Marie Curie-Paris 6, CR7, INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses, CIMI, Team E13 (Bactériologie), Paris, France
| | - J Furin
- Harvard Medical School, Department of Global Health, and Social Medicine, Boston, MA, USA
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - D Chesov
- Department of Pneumology and Allergology, State University of Medicine and Pharmacy 'Nicolae Testemitanu', Chisinau, Republic of Moldova
| | - A Esmail
- Lung Infection and Immunity Unit, Department of Medicine, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Groote Schuur Hospital, Observatory, South Africa
| | - C Lange
- Division of Clinical Infectious Diseases, German Center for Infection Research (DZIF), Research Center Borstel, Borstel, Germany; International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany; Department of Medicine, Karolinska Institute, Stockholm, Sweden; Department of Medicine, University of Namibia School of Medicine, Windhoek, Namibia; German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany
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22
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Sorabella RA, Guglielmetti L, Kantor A, Castillero E, Takayama H, Schulze PC, Mancini D, Naka Y, George I. Cardiac Donor Risk Factors Predictive of Short-Term Heart Transplant Recipient Mortality: An Analysis of the United Network for Organ Sharing Database. Transplant Proc 2016; 47:2944-51. [PMID: 26707319 DOI: 10.1016/j.transproceed.2015.10.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 10/07/2015] [Indexed: 01/15/2023]
Abstract
INTRODUCTION To address the shortage of donor hearts for transplantation, there is significant interest in liberalizing donor acceptance criteria. Therefore, the aim of this study was to evaluate cardiac donor characteristics from the United Network for Organ Sharing (UNOS) database to determine their impact on posttransplantation recipient outcomes. METHODS Adult (≥18 years) patients undergoing heart transplantation from July 1, 2004, to December 31, 2012, in the UNOS Standard Transplant Analysis and Research (STAR) database were reviewed. Patients were stratified by 1-year posttransplantation status; survivors (group S, n = 13,643) and patients who died or underwent cardiac retransplantation at 1-year follow-up (group NS/R = 1785). Thirty-three specific donor variables were collected for each recipient, and independent donor predictors of recipient death or retransplantation at 1 year were determined using multivariable logistic regression analysis. RESULTS Overall 1-year survival for the entire cohort was 88.4%. Mean donor age was 31.5 ± 11.9 years, and 72% were male. On multivariable logistic regression analysis, donor age >40 years (odds ratio [OR] 1.44, 95% confidence interval [CI] 1.27 to 1.64), graft ischemic time >3 hours (OR 1.32, 1.16 to 1.51), and the use of cardioplegia (OR 1.17, 1.01 to 1.35) or Celsior (OR 1.21, 1.06 to 1.38) preservative solution were significant predictors of recipient death or retransplantation at 1 year posttransplantation. Male donor sex (OR 0.83, 0.74 to 0.93) and the use of antihypertensive agents (OR 0.88, 0.77 to 1.00) or insulin (OR 0.84, 0.76 to 0.94) were protective from adverse outcomes at 1 year. CONCLUSIONS These data suggest that donors who are older, female, or have a long projected ischemic time pose greater risk to heart transplant recipients in the short term. Additionally, certain components of donor management protocols, including antihypertensive and insulin administration, may be protective to recipients.
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Affiliation(s)
- R A Sorabella
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - L Guglielmetti
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - A Kantor
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - E Castillero
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - H Takayama
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - P C Schulze
- Division of Cardiology, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - D Mancini
- Division of Cardiology, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Y Naka
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - I George
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA.
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Jaspard M, Guglielmetti L, Lachâtre M, Le Dû D, Marigot – Outtandy D, Veziris N, Robert J, Yazdanpanah Y, Caumes E, Fréchet – Jachym M. MYCOBACT-16 - Tolérance et efficacité d’un traitement prolongé avec bédaquiline dans la tuberculose multi résistante. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30462-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Guglielmetti L, Veziris N, Bernard C, Martin D, Sougakoff W, Raskine L, Antoine D, Tattevin P, Andrejak C, Jarlier V, Robert J. Registre électronique pour la prise en charge, le suivi et la surveillance des cas de tuberculose à bacilles multi-résistants en France. Rev Mal Respir 2015. [DOI: 10.1016/j.rmr.2014.10.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Guglielmetti L, Cazzadori A, Conti M, Boccafoglio F, Vella A, Ortolani R, Concia E. Lymphocyte subpopulations in active tuberculosis: association with disease severity and the QFT-GIT assay [Short communication]. Int J Tuberc Lung Dis 2013; 17:825-8. [DOI: 10.5588/ijtld.12.0361] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- L. Guglielmetti
- Section of Infectious Diseases, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, Policlinico ‘G. B. Rossi’, Verona, Italy
| | - A. Cazzadori
- Section of Infectious Diseases, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, Policlinico ‘G. B. Rossi’, Verona, Italy
| | - M. Conti
- Section of Infectious Diseases, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, Policlinico ‘G. B. Rossi’, Verona, Italy
| | - F. Boccafoglio
- Section of Infectious Diseases, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, Policlinico ‘G. B. Rossi’, Verona, Italy; Department of Pneumology, Trento Hospital, Trento, Italy
| | - A. Vella
- Section of Immunology, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, Policlinico ‘G. B. Rossi’, Verona, Italy
| | - R. Ortolani
- Section of Immunology, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, Policlinico ‘G. B. Rossi’, Verona, Italy
| | - E. Concia
- Section of Infectious Diseases, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, Policlinico ‘G. B. Rossi’, Verona, Italy
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Guglielmetti L, Cazzadori A, Scardigli A, Valentinotti R, Conti M, Concia E. Tuberculosis Incidence at the Burundi-Rwanda Border 15 Years After the Civil War. Clin Infect Dis 2012; 54:155-6. [DOI: 10.1093/cid/cir779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Del Zotti F, Guglielmetti L, Conti M, Valentinotti R, Cazzadori A, Concia E. [Herpes zoster in general medicine: experience of the Italian group Netaudit]. Infez Med 2011; 19:106-112. [PMID: 21753250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Herpes zoster is caused by the reactivation of the varicella-zoster virus (VZV) and usually appears many years after primary infection (varicella), induced by immunosuppression due to underlying diseases. Few epidemiological data in Italy are available concerning Herpes zoster, mainly because disease notification is not mandatory. An observational perspective trial was conducted for 12 months by 41 Italian general practitioners belonging to the Netaudit network to determine herpes zoster incidence and its correlation to patients' characteristics (age, gender, educational qualification, co-morbidities), the delay from correct diagnosis to the start of treatment and different drug prescription. In all, the study involved 193 patients with herpes zoster: this population included mostly female (60.6%) and elderly subjects (59.6%) with a mean age of 60.4 years. 46.1% of patients presented underlying diseases (diabetes 13%, solid tumours 5.7%). Correct diagnosis was achieved after a mean delay of 49 hours while therapy was started within 48 hours in most cases (75.1%). Aciclovir (51%) and valaciclovir (24%) were the most commonly used drugs. A significant correlation between educational level and prompt treatment suggests the major role of education in primary health prevention campaigns.
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