TY - JOUR
T1 - Shorter treatment for multidrug-resistant tuberculosis
T2 - the good, the bad and the ugly
AU - van Altena, Richard
AU - Akkerman, Onno W.
AU - Alffenaar, Jan-Willem C.
AU - Kerstjens, Huib A. M.
AU - Magis-Escurra, Cecile
AU - Boeree, Martin J.
AU - van Soolingen, Dick
AU - de Lange, Wiel C. M.
AU - Bolhuis, Mathieu S.
AU - Hoefsloot, Wouter
AU - de Vries, Gerard
AU - van der Werf, Tjip S.
PY - 2016/12
Y1 - 2016/12
N2 - We welcome the initiative by the Guideline Development Group (GDG) members to issue the 2016 update of World Health Organization (WHO) treatment guidelines for drug-resistant tuberculosis (TB) [1]. With one in two patients currently failing on treatment for multidrug-resistant (MDR)-TB, primarily as a result of the difficulties presented by cumulative drug toxicity, logistics, costs and subsequent poor adherence to therapy [2], a shorter regimen for selected patients would be a tremendous asset, even though the GDG argues that the recommendation is conditional, and the scientific evidence for the recommendation is low. Since the first reports on the efficacy of a regimen of only 9 months for MDR-TB [3, 4], two more studies have been published to support the concept of shorter regimens [5, 6] while the STREAM (Evaluation of a Standard Treatment Regimen of Anti-tuberculosis Drugs for Patients with MDR-TB) study is still enrolling [7]. However, shortening therapy would only apply for selected patients without prior use of or proven resistance to fluoroquinolones (group A) or second-line injectable agents (group B). At least five active drugs should be available for the intensive phase (4–6 months). Further exclusions are extrapulmonary TB, additional resistance to pyrazinamide (PZA) and pregnancy. Clofazimine [8] and linezolid [9] were regrouped as core agents in group C with ethionamide or prothionamide, while para-aminosalicylic acid was deferred to group D.
AB - We welcome the initiative by the Guideline Development Group (GDG) members to issue the 2016 update of World Health Organization (WHO) treatment guidelines for drug-resistant tuberculosis (TB) [1]. With one in two patients currently failing on treatment for multidrug-resistant (MDR)-TB, primarily as a result of the difficulties presented by cumulative drug toxicity, logistics, costs and subsequent poor adherence to therapy [2], a shorter regimen for selected patients would be a tremendous asset, even though the GDG argues that the recommendation is conditional, and the scientific evidence for the recommendation is low. Since the first reports on the efficacy of a regimen of only 9 months for MDR-TB [3, 4], two more studies have been published to support the concept of shorter regimens [5, 6] while the STREAM (Evaluation of a Standard Treatment Regimen of Anti-tuberculosis Drugs for Patients with MDR-TB) study is still enrolling [7]. However, shortening therapy would only apply for selected patients without prior use of or proven resistance to fluoroquinolones (group A) or second-line injectable agents (group B). At least five active drugs should be available for the intensive phase (4–6 months). Further exclusions are extrapulmonary TB, additional resistance to pyrazinamide (PZA) and pregnancy. Clofazimine [8] and linezolid [9] were regrouped as core agents in group C with ethionamide or prothionamide, while para-aminosalicylic acid was deferred to group D.
KW - STANDARDIZED TREATMENT
KW - MDR-TB
KW - REGIMEN
KW - METAANALYSIS
KW - NETHERLANDS
KW - DRUGS
U2 - 10.1183/13993003.01208-2016
DO - 10.1183/13993003.01208-2016
M3 - Letter
C2 - 27824604
SN - 0903-1936
VL - 48
SP - 1800
EP - 1802
JO - European Respiratory Journal
JF - European Respiratory Journal
IS - 6
ER -