(Re)moving the needle: prospects for all-oral treatment for multidrug-resistant tuberculosis
OBJECTIVE: To explore evidence for all-oral treatment regimens.
DESIGN: We review evidence on drugs that could be included in injection-free MDR-TB regimens. The oral drugs considered have an indication for or are recommended for off-label use for TB or MDR-TB, and have demonstrated bactericidal activity. Drugs with weak bactericidal activity should have limited prior population exposure and evidence of effectiveness in MDR-TB regimens.
RESULTS: Bedaquiline, delamanid, and linezolid all display strong bactericidal activity, while clofazimine has weak bactericidal activity. They all have limited prior population exposure and demonstrated effectiveness in MDR-TB regimens. Despite widespread exposure to pyrazinamide and late-generation fluoroquinolones in the population, all are bactericidal and have shown great value when included in treatment regimens for MDR-TB.
CONCLUSION: The evidence supports the use of all-oral regimens comprising new and existing drugs for MDR-TB treatment. Existing evidence of bactericidal activity and efficacy for these drugs provides a convincing argument for transitioning MDR-TB treatment towards all-oral regimens. These new regimens could mitigate the delivery, cost, and adherence challenges inherent to the current standard.
Document Type: Research Article
Affiliations: 1: Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Bouvé College of Health Sciences, Northeastern University, Boston, USA 2: Harvard Medical School, Boston, Massachusetts, USA 3: Medical Department, Médecins Sans Frontières, Paris, France 4: Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Partners In Health, Boston, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
Publication date: December 1, 2016
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