Tuberculosis: progress and advances in development of new drugs, treatment regimens, and host-directed therapies

Simon Tiberi, Nelita du Plessis, Gerhard Walzl, Michael J Vjecha, Martin Rao, Francine Ntoumi, Sayoki Mfinanga, Nathan Kapata, Peter Mwaba, Timothy D McHugh, Giuseppe Ippolito, Giovanni Battista Migliori, Markus J Maeurer, Alimuddin Zumla

Research output: Contribution to journalReview article

Abstract

Tuberculosis remains the world's leading cause of death from an infectious disease, responsible for an estimated 1 674 000 deaths annually. WHO estimated 600 000 cases of rifampicin-resistant tuberculosis in 2016-of which 490 000 were multidrug resistant (MDR), with less than 50% survival after receiving recommended treatment regimens. Concerted efforts of stakeholders, advocates, and researchers are advancing further development of shorter course, more effective, safer, and better tolerated treatment regimens. We review the developmental pipeline and landscape of new and repurposed tuberculosis drugs, treatment regimens, and host-directed therapies (HDTs) for drug-sensitive and drug-resistant tuberculosis. 14 candidate drugs for drug-susceptible, drug-resistant, and latent tuberculosis are in clinical stages of drug development; nine are novel in phase 1 and 2 trials, and three new drugs are in advanced stages of development for MDR tuberculosis. Specific updates are provided on clinical trials of bedaquiline, delamanid, pretomanid, and other licensed or repurposed drugs that are undergoing investigation, including trials aimed at shortening duration of tuberculosis treatment, improving treatment outcomes and patient adherence, and reducing toxic effects. Ongoing clinical trials for shortening tuberculosis treatment duration, improving treatment outcomes in MDR tuberculosis, and preventing disease in people with latent tuberculosis infection are reviewed. A range of HDTs and immune-based treatments are under investigation as adjunctive therapy for shortening duration of therapy, preventing permanent lung injury, and improving treatment outcomes of MDR tuberculosis. We discuss the HDT development pipeline, ongoing clinical trials, and translational research efforts for adjunct tuberculosis treatment.

Original languageEnglish
Pages (from-to)e183-e198
JournalThe Lancet Infectious Diseases
Volume18
Issue number7
DOIs
Publication statusPublished - Jul 2018

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Tuberculosis
Multidrug-Resistant Tuberculosis
Pharmaceutical Preparations
Drug Repositioning
Therapeutics
Latent Tuberculosis
Clinical Trials
bedaquiline
Translational Medical Research
Poisons
Lung Injury
Rifampin
Patient Compliance
Communicable Diseases
Cause of Death
Research Personnel
Drug Therapy

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Tuberculosis : progress and advances in development of new drugs, treatment regimens, and host-directed therapies. / Tiberi, Simon; du Plessis, Nelita; Walzl, Gerhard; Vjecha, Michael J; Rao, Martin; Ntoumi, Francine; Mfinanga, Sayoki; Kapata, Nathan; Mwaba, Peter; McHugh, Timothy D; Ippolito, Giuseppe; Migliori, Giovanni Battista; Maeurer, Markus J; Zumla, Alimuddin.

In: The Lancet Infectious Diseases, Vol. 18, No. 7, 07.2018, p. e183-e198.

Research output: Contribution to journalReview article

Tiberi, S, du Plessis, N, Walzl, G, Vjecha, MJ, Rao, M, Ntoumi, F, Mfinanga, S, Kapata, N, Mwaba, P, McHugh, TD, Ippolito, G, Migliori, GB, Maeurer, MJ & Zumla, A 2018, 'Tuberculosis: progress and advances in development of new drugs, treatment regimens, and host-directed therapies', The Lancet Infectious Diseases, vol. 18, no. 7, pp. e183-e198. https://doi.org/10.1016/S1473-3099(18)30110-5
Tiberi, Simon ; du Plessis, Nelita ; Walzl, Gerhard ; Vjecha, Michael J ; Rao, Martin ; Ntoumi, Francine ; Mfinanga, Sayoki ; Kapata, Nathan ; Mwaba, Peter ; McHugh, Timothy D ; Ippolito, Giuseppe ; Migliori, Giovanni Battista ; Maeurer, Markus J ; Zumla, Alimuddin. / Tuberculosis : progress and advances in development of new drugs, treatment regimens, and host-directed therapies. In: The Lancet Infectious Diseases. 2018 ; Vol. 18, No. 7. pp. e183-e198.
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AU - Ippolito, Giuseppe

AU - Migliori, Giovanni Battista

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