MDR-TB TREATMENT UPDATE

Abstract

Rifampicin-resistant tuberculosis (RR-TB) accounts for an expanding proportion of incident global TB cases and is a major barrier to global tuberculosis control. Conventional therapy for RR-TB is more toxic, less effective, and much more costly than drug-susceptible TB. Treatment success has been consistently lower than 60% and, prior to widespread introduction of new drugs, RR-TB resulted in a quarter million deaths annually. There is a clear need for more effective, safe, and well-tolerated drugs to support shorter and injection-free treatment regimens, improve adherence, and interrupt the cycle of resistance amplification and transmission of RR-TB. Key strategies to achieve this include dose optimization of approved drugs, introduction of potent new and repurposed drugs, and design of novel combination regimens that are better tolerated and more effective at preventing transmission and relapse. This session will summarize major recent advances in the clinical development of new and repurposed antituberculosis drugs, review the evidence that has shaped current treatment guidelines, and discuss ongoing phase 2/3 trials evaluating novel regimens for drug-resistant TB. Challenges in clinical trial design, dose optimisation and emergence of drug resistance will also be covered.