Short-course treatment for multidrug-resistant tuberculosis: the STREAM trials

Abstract

Multidrug-resistant (MDR) tuberculosis (TB) is a threat to global TB control, as suboptimal and poorly tolerated treatment options have resulted in largely unfavourable outcomes for these patients. The last of six cohort studies conducted in Bangladesh which assessed a new shorter regimen using currently available TB drugs showed promising results and offered the possibility of a more acceptable and more effective regimen than the one recommended by the World Health Organization (WHO). The aims of stage 1 of the STREAM (Evaluation of a Standardised Treatment Regimen of Anti-tuberculosis Drugs for Patients with Multidrug-resistant Tuberculosis) trial are to evaluate the efficacy and safety of this regimen, compared to the current WHO-recommended standard of care. Stage 2 evaluates two new bedaquiline-containing regimens: one an all-oral regimen and the second a further shortened and simplified version of the stage 1 study regimen, comparing the efficacy and safety of each to that of the stage 1 study regimen and also to the WHO-recommended standard of care. Success of the stage 1 study regimen would in all probability provide a new standard of care for MDR-TB patients, while positive results from the bedaquiline-containing regimens in stage 2 may allow for even greater progress in the management of this difficult population. @ERSpublications A review of the STREAM trial, which evaluates the safety and efficacy of new treatment regimens for MDR-TB http://ow.ly/VtVkQ

Hearing loss with kanamycin treatment for multidrug-resistant tuberculosis in Bangladesh

“…Clinical trials are underway with regimens that exclude aminoglycosides, but depend upon the activity of oral drugs including fluoroquinolones [7]. Yet in prior studies of MDR-TB in Bangladesh, we found high proportions of patients with M. tuberculosis isolates with resistance or borderline susceptibility to fluoroquinolones, while susceptibility to an aminoglycoside was retained [8].…”

Individualizing management of extensively drug-resistant tuberculosis: diagnostics, treatment, and biomarkers

“…Ideally, using molecular assays provide rapid results. Rapid diagnosis of (pre-)XDR is becoming important especially now that the 9-month 'Bangladesh' regimen is showing promise [99,100] and results from a clinical trial are expected soon [101]. WHO recently endorsed this short-course regimen for MDR-TB [19].…”

Multidrug-resistant TB in Eastern region of the EU: is the shorter regimen an exception or a rule?

“…It is not recommended for pregnant women and patients with extrapulmonary TB 1. This recommendation is based on observational studies2–4 as well as on the STREAM (Evaluation of a Standardised Treatment Regimen of Anti-tuberculosis Drugs for Patients with Multidrug-resistant Tuberculosis) trial performed in Asia and Africa 5…”