Potentially serious side effects and thousands of tablets to be taken over a year or two. Treatments for drug-resistant tuberculosis – cases of the disease caused by strains of bacteria against which initial treatment drugs are ineffective – are stressful for patients. In 2022, according to the World Health Organization (WHO), 175,000 newly diagnosed people received this care, with an estimated 410,000 new cases. In total, tuberculosis killed 1.3 million people last year, mostly in low- and middle-income countries, making it the deadliest infectious disease.

For years, research has attempted to find shorter, more effective and better-tolerated treatments by comparing different combinations of second-line antibiotics. New advances in the EndTB clinical trial, organized by Médecins sans frontières, Partners In Health and the IRD Institute in Dubai and funded by the Unitaid organization, were presented in Paris during the World Conference on Lung Health on Wednesday 15 September became.

Launched in 2017, EndTB sought to use a sample of 754 people in seven countries to determine that new drug combinations were no less effective than standard WHO-approved treatments. Two new molecules were involved – bedaquiline, which has been at the heart of the fight against drug-resistant tuberculosis since its release in the early 2010s, and delamanid – as well as clofazimine, linezolid, quinolone and pyrazimanid. The treatments with the new combinations had the advantage of lasting only nine months, compared to eighteen months for the current standard treatments.

“Suggest different combinations”

Of the five combinations tested, three demonstrated efficacy rates of 85.2% to 90.4%, higher than the reference treatment (80.7%). A fourth batch of molecules has not officially proven its competitiveness, but does not contain bedaquiline or linezolid and therefore, in the eyes of researchers, represents an interesting alternative for patients who cannot tolerate these molecules.

EndTB-backed treatments last longer than some of the latest WHO-recommended combinations, lasting six months. However, according to Lorenzo Guglielmetti, head of the EndTB project at Médecins sans frontières and one of the study’s principal investigators, they significantly expand the range of tools available. “In order to best treat each patient, different combinations must be offered due to intolerances, allergies or the unavailability of certain molecules in certain countries. he emphasizes. In real life you need multiple options. »

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