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Seung KJ, Khan U, Varaine F, Ahmed S, Bastard M, Cloez S, Damtew D, Franke MF, Herboczek K, Huerga H, Islam S, Karakozian H, Khachatryan N, Kliesckova J, Khan AJ, Khan M, Khan P, Kotrikadze T, Lachenal N, Lecca L, Lenggogeni P, Maretbayeva S, Melikyan N, Mesic A, Mitnick CD, Mofolo M, Perrin C, Richard M, Tassew YM, Telnov A, Vilbrun SC, Wanjala S, Rich ML, Hewison C. Introducing new and repurposed TB drugs: the endTB experience. Int J Tuberc Lung Dis 2020; 24:1081-1086. [PMID: 33126943 DOI: 10.5588/ijtld.20.0141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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
In 2015, the initiative Expand New Drug Markets for TB (endTB) began, with the objective of reducing barriers to access to the new and repurposed TB drugs. Here we describe the major implementation challenges encountered in 17 endTB countries. We provide insights on how national TB programmes and other stakeholders can scale-up the programmatic use of new and repurposed TB drugs, while building scientific evidence about their safety and efficacy. For any new drug or diagnostic, multiple market barriers can slow the pace of scale-up. During 2015-2019, endTB was successful in increasing the number of patients receiving new and repurposed TB drugs in 17 countries. The endTB experience has many lessons, which are relevant to country level introduction of new TB drugs, as well as non-TB drugs and diagnostics. For example: the importation of TB drugs is possible even in the absence of registration; emphasis on good clinical monitoring is more important than pharmacovigilance reporting; national guidelines and expert committees can both facilitate and hinder innovative practice; clinicians use new and repurposed TB drugs when they are available; data collection to generate scientific evidence requires financial and human resources; pilot projects can drive national scale-up.
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Affiliation(s)
- K J Seung
- Partners In Health (PIH), Brigham and Women´s Hospital, Harvard Medical School, Boston, MA, USA
| | - U Khan
- Interactive Research and Development (IRD) Global, Singapore
| | - F Varaine
- Médecins Sans Frontières (MSF), Paris, France
| | | | - M Bastard
- Field Epidemiology Department, Epicentre, Paris, France
| | - S Cloez
- Médecins Sans Frontières (MSF), Paris, France
| | - D Damtew
- Ministry of Health, Addis Ababa, Ethiopia
| | - M F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, PIH, Boston, MA, USA
| | | | - H Huerga
- Field Epidemiology Department, Epicentre, Paris, France
| | | | | | | | | | - A J Khan
- Interactive Research and Development (IRD) Global, Singapore
| | - M Khan
- IRD, Durban, South Africa
| | - P Khan
- Interactive Research and Development (IRD) Global, Singapore
| | | | | | | | | | | | - N Melikyan
- Field Epidemiology Department, Epicentre, Paris, France
| | | | - C D Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, PIH, Boston, MA, USA
| | | | - C Perrin
- Médecins Sans Frontières (MSF), Paris, France
| | - M Richard
- Programme national de Lutte contre la Tuberculose, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | | | | | - S C Vilbrun
- Groupe Haitien d´Etudes du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti
| | | | - M L Rich
- Partners In Health (PIH), Brigham and Women´s Hospital, Harvard Medical School, Boston, MA, USA
| | - C Hewison
- Médecins Sans Frontières (MSF), Paris, France
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Hewison C, Bastard M, Khachatryan N, Kotrikadze T, Hayrapetyan A, Avaliani Z, Kiria N, Yegiazaryan L, Chumburidze N, Kirakosyan O, Atshemyan H, Qayyum S, Lachenal N, Varaine F, Huerga H. Is 6 months of bedaquiline enough? Results from the compassionate use of bedaquiline in Armenia and Georgia. Int J Tuberc Lung Dis 2019; 22:766-772. [PMID: 29914602 DOI: 10.5588/ijtld.17.0840] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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 AND SETTING Bedaquiline (BDQ) was initially only available through compassionate use programmes. OBJECTIVE To assess the effectiveness and safety of multidrug-resistant tuberculosis (MDR-TB) treatment containing BDQ. METHOD Retrospective analysis of data from patients receiving BDQ through compassionate use in Armenia and Georgia from April 2013 to April 2015. Logistic regression was used to assess the risk factors associated with unsuccessful treatment outcomes. RESULTS Of 82 patients included, 84.2% (69/82) had fluoroquinolone-resistant MDR-TB and 43.4% (23/53) were seropositive for the hepatitis C virus (HCV). The culture conversion rate was 84.4% (54/64), and 18.5% (10/54) reverted back to positive. In total, 79.3% (65/82) of the patients reported at least one adverse event. Serious adverse events were reported in 14 patients, with 10/14 patients experiencing fatal outcomes-6/10 related to advanced TB and 2/10 assessed as possibly related to BDQ. Treatment outcomes were as follows: 58.5% treatment success, 12.2% deaths, 7.3% failures and 21.9% lost to follow-up. HCV coinfection was associated with unsuccessful outcomes (adjusted OR 4.45, 95%CI 1.23-16.13). CONCLUSION BDQ through compassionate use showed relatively good success rates and safety profiles in a cohort with difficult-to-treat MDR-TB. High rates of reversion may indicate that >24 weeks of BDQ is necessary in some cases. HCV coinfection should be diagnosed and treatment considered in MDR-TB patients.
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Affiliation(s)
- C Hewison
- Médecins Sans Frontières (MSF), Paris
| | | | | | | | - A Hayrapetyan
- National Tuberculosis Control Centre, Yerevan, Armenia
| | - Z Avaliani
- National Centre for Tuberculosis and Lung Disease, Tbilisi, Georgia
| | - N Kiria
- National Centre for Tuberculosis and Lung Disease, Tbilisi, Georgia
| | - L Yegiazaryan
- National Tuberculosis Control Centre, Yerevan, Armenia
| | | | | | | | - S Qayyum
- Migration Health Department, International Organization for Migration, Amman, Jordan, MSF, Yerevan, Armenia
| | | | - F Varaine
- Médecins Sans Frontières (MSF), Paris
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Ardizzoni E, Mulders W, Kotrikadze T, Aspindzelashvili R, Goginashvili L, Pangtey H, Varaine F, Bastard M, Rigouts L, de Jong BC. The thin-layer agar method for direct phenotypic detection of multi- and extensively drug-resistant tuberculosis. Int J Tuberc Lung Dis 2016; 19:1547-52. [PMID: 26614200 DOI: 10.5588/ijtld.15.0136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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 Molecular techniques rapidly detect resistance to rifampicin (RMP) and isoniazid (INH), but do not eliminate the need for culture-based drug susceptibility testing (DST) against other drugs. The thin-layer agar (TLA) test, a non-commercial direct DST method, has demonstrated good performance for INH and RMP; however, evidence is still limited, and its applicability for DST of ofloxacin (OFX) and kanamycin (KM) is unknown. DESIGN We compared 279 TLA DST results with those of MGIT for INH and RMP, and 280 results for OFX and KM with those of the 7H11 agar proportion method, obtained from 320 smear-positive samples from 165 Georgian TB patients. Discrepancies were solved by comparison with a composite reference standard. The prevalence of multidrug-resistant tuberculosis (TB) was 30 of 164 patients (18.3%), 2 (6.7%) of whom had extensively drug-resistant TB. RESULTS TLA showed 94.7%, 98.2%, 100% and 78.9% sensitivity, respectively, for INH, RMP, OFX and KM, with 100% specificity. Average time to results was 7 days in TLA, 23 in MGIT and 49 for 7H11 agar. CONCLUSIONS In low-resource settings, TLA can be applied for the rapid detection of resistance to INH, RMP and fluoroquinolones. Further studies are necessary to improve sensitivity to KM and further assess its performance for OFX and other drugs and its applicability in field conditions.
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Affiliation(s)
- E Ardizzoni
- Institute of Tropical Medicine, Antwerp, Belgium; Médecins Sans Frontières, Paris, France
| | - W Mulders
- Institute of Tropical Medicine, Antwerp, Belgium
| | - T Kotrikadze
- National Tuberculosis Programme, Tbilisi, Georgia
| | | | | | - H Pangtey
- Médecins Sans Frontières, Paris, France
| | - F Varaine
- Médecins Sans Frontières, Paris, France
| | | | - L Rigouts
- Institute of Tropical Medicine, Antwerp, Belgium
| | - B C de Jong
- Institute of Tropical Medicine, Antwerp, Belgium;New York University, New York, New York, USA
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