Pan-tuberculosis regimens: an argument against

Dheda, Keertan; Gumbo, Tawanda; Lange, Christoph; Horsburgh, C. Robert; Furin, Jennifer

doi:10.1016/s2213-2600(18)30097-3

Cited by 19 publications

(13 citation statements)

References 10 publications

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“…The potential utility of a pan-tuberculosis regimen must be considered together with person-centred approaches to treatment, and tailored to pharmacogenetics, comorbidities, and drug coadministration, as well as the risk of new forms of resistance. 317 A diversified portfolio of therapeutic products offers the best hope for long-term success; however, substantial investment in the short-tomedium term is needed to guarantee those products reach the market.…”

Section: Therapeuticsmentioning

confidence: 99%

Building a tuberculosis-free world: The Lancet Commission on tuberculosis

et al. 2019

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growing political momentum to definitively address tuberculosis, could all make ending the pandemic within a generation more feasible than ever before. Moving forward with bold, comprehensive strategies Globally, the priority must be to deliver person-centred and family-centred services to all individuals with tuberculosis who present to care. This approach means ensuring that high-quality diagnostics, treatment, and prevention modalities are available to all, wherever they seek care. Improving quality of tuberculosis care in the private sector is crucial to end tuberculosis in high incidence countries such as India, the country with the highest tuberculosis burden. Modelling shows that optimising private sector engagement in India could avert 8 million deaths from tuberculosis between 2019 and 2045 (appendix p 3). In high drug-resistant tuberculosis burden countries, access to rapid drug susceptibility testing (DST) and second-line drugs is essential to success. In Moldova, where more than 25% of all tuberculosis cases are drug-resistant, improving access to DST and second-line drugs would reduce mortality from drug-resistant tuberculosis by 44% in the coming generation (appendix p 3). Secondly, tuberculosis programme budgets must increase to enable reaching these people and populations at high risk of tuberculosis. In Kenya, for example, where the proportions of HIV and tuberculosis coinfection are high, scaling up access to both antiretroviral therapy and tuberculosis preventive therapy can help save an additional 3 million lives over the next generation (appendix p 3). However, ultimately, the fight against tuberculosis will not be won unless countries also ensure that everyone, not just high-risk groups, can access essential health Key messages The Commission recommends five priority investments to achieve a tuberculosis-free world within a generation. These investments are designed to fulfil the mandate of the UN High Level Meeting on tuberculosis. In addition, they answer the question of how countries with high-burden tuberculosis and their development partners should target their future investments to ensure that ending tuberculosis is achievable. Invest first to ensure that high quality rapid diagnostics and treatment are provided to all individuals receiving care for tuberculosis, wherever they seek care This priority includes rapid drug susceptibility testing and second-line treatment for resistant forms of tuberculosis. Achieving universal, high-quality person-centred and family-centred care-including sustained improvement in the performance of private sector providers-usually should be the top policy and budget priority. Reach people and populations at high risk for tuberculosis (such as household and other close contacts of people with tuberculosis, and people with HIV) and bring them into care Active case-finding and treatment in high-risk populations demands adequate resources to reach and care for these populations. At the same time, reaching certain high-risk populations, such as people co-infec...

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Section: Therapeuticsmentioning

confidence: 99%

Building a tuberculosis-free world: The Lancet Commission on tuberculosis

et al. 2019

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“…5 However, 30 years of its global use has revealed the serious limitations of depending on a single, one-size-fits-all regimen to treat a challenging infectious disease. 6 Predictable toxicities and the development of resistance are directly relevant to ongoing efforts to develop other regimens, 7 including the new regimen studied by Conradie et al…”

Section: Triumph and Tragedy Of 21st Century Tuberculosis Drug Develomentioning

confidence: 99%

Triumph and Tragedy of 21st Century Tuberculosis Drug Development

Thwaites

Nahid

2020

N Engl J Med

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“…The value of a "pan-TB" regimen has been put into question because of the likelihood that resistance to any new drugs would eventually develop [11]. A limitation of our present analysis is that it does not address these issues of drug resistance.…”

Section: Plos Onementioning

confidence: 99%

“…Another important consideration, that we have not addressed in the current work, is the potential for adverse events to a future drug regimen [11]. Particularly in the context of drug resistance, discussed above, some patients will suffer regimen toxicity without having clinical benefit from the regimen.…”

Section: Plos Onementioning

confidence: 99%

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The potential deployment of a pan-tuberculosis drug regimen in India: A modelling analysis

et al. 2020

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There is increasing interest in future, highly-potent 'pan-TB' regimens against tuberculosis (TB), that may be equally effective in both drug-susceptible and rifampicin-resistant (RR) forms of TB. Taking the example of India, the country with the world's largest burden of TB, we show that adoption of these regimens could be: (i) epidemiologically impactful, and (ii) cost-saving to the national TB programme, even if the regimen itself is more costly than current TB treatment. Mathematical modelling suggests that deployment of a pan-TB regimen in 2022 would reduce the annual incidence of TB in 2030 by 23.9% [95% Bayesian credible intervals [CrI] 17.6-30.8%] if used to treat all TB cases, and by 2.30% [95% CrI 1.57-3.48%] if used to treat only RR-TB. Notably, with a regimen costing less than USD 359 (95% CrI 287-441), treating all diagnosed TB cases with the pan-TB regimen yielded greater cost-savings than treating just those diagnosed with RR-TB. One limitation of our approach is that it does not capture the risk of resistance to the new regimen. We discuss ways in which this risk could be mitigated using modern adherence support mechanisms, as well as drug sensitivity testing at the point of TB diagnosis, to prevent new resistant forms from becoming established. A combination of such approaches would be important for maximising the useful lifetime of any future regimen.

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Pan-tuberculosis regimens: an argument against

Cited by 19 publications

References 10 publications

Building a tuberculosis-free world: The Lancet Commission on tuberculosis

Building a tuberculosis-free world: The Lancet Commission on tuberculosis

Triumph and Tragedy of 21st Century Tuberculosis Drug Development

The potential deployment of a pan-tuberculosis drug regimen in India: A modelling analysis

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