“Mumbai, India, has a particular problem as there are many MDR strains of bacteria that are resistant to the second-best medicine, fluoroquinolone. Hence, we need new medicines to combat drug-resistant tuberculosis. What is promising is that there are much shorter TB treatment regimens. We have 17 new medicines in the drug pipeline in phase 1 and 2 studies that will be soon evaluated in clinical trials,” he says.

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“There have never been so many clinical compounds as we have today. Take for instance the field of HIV infection and Hepatitis-C therapy, where there were an enormous number of novel medicines that had a huge impact on the control of the disease. This did not take place for TB as there were not enough drugs,” Dr. Lange observes.

Personalized Medicine for Tuberculosis

He believes that biomarkers from urine and blood samples have enormous promise for determining the length of TB treatment in the future. Precision or personalized medicine is the customization of illness prevention and treatment to specific genes, surroundings, and lifestyles and provides treatment to the right patient at the right time.

“My dream is that one day we will have TB treatment for two weeks. Why not? We are treating other forms of pneumonia for five days; TB is just pneumonia caused by another bacterium that is mainly different because the replication time is slow. Most medicines work by attacking the bacteria while they replicate, for instance, by inhibiting the building of new cell walls. I think it is possible to shut down the energy supply of the bacteria by blocking the production of one substance (ATP) that is required as an energy value in the bacteria to survive,” says Dr. Lange.

The advent of drug-resistant TB, followed by the COVID-19 epidemic, harmed TB control, with the annual burden of MDR-TB estimated by the Global TB Report 22 at half a million people.

Dr. Zarir Udwadia, a renowned pulmonologist at Hinduja Hospital, believes it is a major underestimation, and that at least 4.1 million instances of tuberculosis may have gone undiscovered as a result of COVID-19. On a more positive note, the expert claims that the MDR-TB treatment environment is changing at a breakneck pace and that the worldwide TB medication pipeline now includes three new treatments: bedaquiline, delamanid, and protomanid. There are novel treatment regimens that combine new and repurposed medications with several randomized controlled trials (RCTs), and the results are promising in terms of dramatically better outcomes.

“Despite several trials underway, the success and sustainability of all the new TB treatment regimens will depend on four factors: toxicity, resistance that will develop to these therapies, cost, and access,” Dr. Udwadia says. He adds that the programme has improved, but the availability of drugs like bedaquiline has not translated into widespread access.

Dr. Camilla Rodrigues, Consultant Microbiologist at Hinduja Hospital, says India has come a long way since 2012, and today the TB diagnostic pipeline is so much richer and better. “Still, after all this, only one in three people with MDR-TB are put on treatment,” Dr. Rodrigues says, adding that it is also time to build upon unprecedented opportunities in the field by getting accurate tests to detect tuberculosis for effective control.

Source: Medindia