The Time Is Right For Trials Of Multidrug-Resistant TB Therapy

Main Category: Tuberculosis
Also Included In: Respiratory / Asthma;  Clinical Trials / Drug Trials
Article Date: 05 Nov 2007 - 17:00 PDT

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Drug-resistant TB strains may account for 10% of the 8 million new cases of TB that occur each year, say Carole Mitnick (Harvard Medical School, Boston, USA) and colleagues. Increasing concern about resistance has redoubled interest in strategies to control drug-resistant TB, they say, especially in settings of high HIV prevalence.

Current treatments for MDR-TB last between 18 and 24 months, adverse effects are common, and many patients cannot be cured.

However, the time is now right, say Mitnick and colleagues, to conduct randomized clinical trials of new regimens for treating MDR-TB. For a start, MDR-TB treatment programs have expanded dramatically: 40 programs in resource-limited settings are managing treatment for nearly 30,000 patients. These treatment programs provide the settings in which trials can be implemented. In addition, for the first time in 30 years, several new drug classes hold promise for MDR-TB treatment.

"Four elements are needed," say the authors, "to make MDR-TB treatment trials a reality: money; additional work on the drug pipeline; rigorous, interdisciplinary preclinical work on individual agents and regimens; and an understanding that TB clinical trials need not be a zero-sum endeavor."

Citation: Mitnick CD, Castro KG, Harrington M, Sacks LV, Burman W (2007) Randomized trials to optimize treatment of multidrug-resistant tuberculosis. PLoS Med 4(11): e292.
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