Ahead of the annual meeting of the European Respiratory Society (Madrid, Spain, Sept 28–Oct 2), we publish together with The Lancet Respiratory Medicine a three-part Series on tuberculosis. This Series, which focuses on the management of drug-resistant tuberculosis, challenges in childhood tuberculosis, and the state of vaccine development, will be discussed in a special symposium at the conference. Tuberculosis is now the most common and deadly infectious disease. An estimated 1·6 million people die from the disease annually, including 230 000 children. The Lancet Commission on tuberculosis, published in March this year, sadly concluded that little has changed over the past decade.
About 4·6% of patients globally have multidrug-resistant tuberculosis, although in some countries, such as Kazakhstan and Ukraine, the percentage is much higher (more than 25%). Christoph Lange and colleagues review the optimal diagnostic and treatment strategies in these patients. On Aug 14, the US Food and Drug Administration approved the oral drug pretonamid, a nitroimidazole, as part of an oral, three-drug regimen (together with bedaquiline and linezolid) over 6 months. It has been hailed as a landmark decision for patients with very few choices. The decision was based on an open-label, uncontrolled, small trial of 107 patients with extensively drug-resistant disease, in which 95 (89%) patients achieved a culture-negative status at 6 months—a remarkable cure rate compared with historical results of only about 34% with multidrug regimens for 18–24 months. The drug was only the second approved under the so-called Limited Population Pathway for Antibacterial and Antifungal Drugs and was developed and licensed by the TB Alliance in partnership with Mylan under a public–private partnership model.
Although this development is a welcome new option, which hopefully will also be adopted by the European Medicines Agency and WHO, there is much to do to improve diagnosis and case finding (including drug resistance testing), especially in children younger than 14 years. Without greatly accelerated efforts, the goal of a tuberculosis-free world will remain a noble but distant dream.
Published: 14 September 2019
© 2019 Elsevier Ltd. All rights reserved.