Treatment of tuberculosis: have we turned the corner?
The question the tuberculosis community is anxiously posing is whether, in addition to existing drugs, the most promising compounds in the development pipeline are as effective as preliminary studies suggested.
The number of multidrug-resistant (MDR) tuberculosis cases officially reported to WHO increased from 29 000 to 53 000 between 2008 and 2010, still representing only 18% of the estimated 290 000 patients potentially identifiable if drug susceptibility testing was done in all notified cases of tuberculosis. A recent study done in Belarus showed a new global record for prevalence of MDR tuberculosis with 35·3% of new patients and 76·5% of previously treated patients diagnosed with the disease. This finding clearly shows how far case mismanagement can affect the chances to control (and eventually eliminate) the disease. Unfortunately, since only a quarter of patients with tuberculosis are treated according to established standards and the proportion of treatment success does not exceed 50%, extensively drug-resistant (XDR) tuberculosis has already been reported in 77 countries and totally drug resistant cases (ie, Mycobacterium tuberculosis strains with resistance to all known drugs) have been recently described in Italy, Iran, and India.
The urgent need for new drugs is obvious. The question the tuberculosis community is anxiously posing is whether, in addition to existing drugs, the most promising compounds in the development pipeline (delamanid, bedaquiline, and PA-824) are as effective as preliminary studies suggested. Gler and colleagues and Diacon and colleagues provided part of the answer when they reported that delamanid in combination with a background regimen developed according to WHO guidelines, is associated with an increase in sputum-culture conversion at 2 months in patients with MDR tuberculosis.
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The Lancet
