2023-11-18 08:30:07
A scientist manipulates the Koch bacillus, responsible for tuberculosis, in the laboratory of the infectious diseases research center of the Infection Méditerranéenne University Hospital Institute, in Marseille, March 29, 2018. ANNE-CHRISTINE POUJOULAT / AFP
Potentially severe side effects and thousands of tablets to ingest over one or two years. Treatments for drug-resistant tuberculosis – cases of the disease caused by bacterial strains against which first-line drugs have no effect – are burdensome for patients. In 2022, according to the World Health Organization (WHO), 175,000 newly diagnosed people received this care, out of an estimated 410,000 new cases. All forms combined, tuberculosis killed 1.3 million people last year, mainly in low- and middle-income countries, making it the deadliest infectious disease.
For years, research has been striving to find shorter, more effective and better tolerated treatments, by comparing different combinations of second-line antibiotics. Wednesday September 15 in Paris, during the World Conference on Lung Health, new advances were presented as part of the EndTB clinical trial organized by Médecins sans frontières, Partners In Health and the Research Institute for Development from Dubai, and financed by the Unitaid organization.
Launched in 2017, EndTB sought to establish, within a sample of 754 people across seven countries, that new drug combinations are no less effective than standard treatments approved by the WHO. Two recent molecules were involved – bedaquiline, at the heart of the fight against drug-resistant tuberculosis since its launch on the market in the early 2010s, and delamanid – as well as clofazimine, linezolid, quinolone and pyrazinamide. The treatments using the new combinations had the advantage of only lasting nine months, compared to eighteen months for the standard treatments in force.
“Suggest different combinations”
Among the five combinations tested, three showed effectiveness rates of 85.2% to 90.4%, higher than that of the reference treatment (80.7%). A fourth batch of molecules has not formally proven its competitiveness, but it does not contain bedaquiline or linezolid, and therefore represents, in the eyes of researchers, an interesting alternative for patients who do not tolerate these molecules.
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The treatments promoted by EndTB are longer than some of the latest combinations recommended by the WHO, lasting six months. But they significantly increase the range of tools available, according to Lorenzo Guglielmetti, director of the EndTB project at Médecins sans frontières and one of the principal investigators of the study. “To best treat each patient, different combinations must be offered for reasons of intolerance, allergies or the unavailability of certain molecules in certain countries, he emphasizes. In real life, you need several options. »
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