Tuberculosis future or investigational therapies: Difference between revisions

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{{CMG}} ; {{AE}} {{Mashal Awais}}; {{Ammu}} ; {{marjan}}
{{CMG}} ; {{AE}} {{Mashal Awais}}; {{Ammu}} ; {{marjan}}
==Overview==
==Overview==
Since new drug-resistant tuberculosis has been emerging, the role of future therapies is vital in curbing outbreaks. The new drugs are required to be more effective than the current regimen and a few drugs in clinical trials have been showing good results.
With emergence of new drug-resistant tuberculosis, the role of future therapies is crucial in curbing outbreaks. The new drugs should be more effective than the current regimen and a few drugs in clinical trials have been showing promising results.


==Future investigations==
==Future investigations==


===Principles of future investigations===
===Principles of future investigations===
Any future regimen should satisfy the following principles. <ref name="Cost">{{cite web | title = Future therapy purposed by WHO| url = http://www.who.int/bulletin/volumes/92/1/13-122028/en/}}</ref>
Any future regimen must fulfill the following recommendations: <ref name="Cost">{{cite web | title = Future therapy purposed by WHO| url = http://www.who.int/bulletin/volumes/92/1/13-122028/en/}}</ref>


*It should not have more than a maximum duration of 6 months
*It should not have more than a maximum duration of 6 months
*The dosing schedule must be simple
*The dosing schedule must be simple
*The number of drugs ideally should not be more than 3-5 drug from a different class
*The ideal number of drugs should not exceed 3-5 drug from a different class
*It should have a minimum side effect profile so that we could have minimum monitoring
*It should have a minimum side effect profile so that we could have minimum monitoring
*It should be effective against [[MDR]], [[XDR]], and [[XXDR]] strains
*It should be effective against [[MDR]], [[XDR]], and [[XXDR]] strains
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==Tuberculosis vaccine development==
==Tuberculosis vaccine development==


*Neonatal BCG vaccination is partially effective at protecting infants and children, particularly from the most severe consequences of TB disease.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO &#124; Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*[[Infant|Neonatal]] [[BCG]] [[vaccination]] is partially effective at protecting infants and children, especially from the most severe [[complications]] of [[Tuberculosis|TB]] disease.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO &#124; Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*BCG is poorly protective against pulmonary disease in adults, and therefore at reducing Mycobacterium tuberculosis transmission.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO &#124; Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*[[BCG]] is poorly effective at protecting against [[pulmonary disease]] in adults, and hence at decreasing [[Mycobacterium tuberculosis]] [[Transmission (medicine)|transmission]].<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO &#124; Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*A new novel vaccine is warranted in decreasing the incidence and mortality of Tuberculosis; a vaccine that is effective in adult individuals who have not yet been infected with Mycobacterium tuberculosis, as well as in those with latent Mycobacterium tuberculosis infection.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO &#124; Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*A new novel vaccine is needed to reduce the [[Incidence (epidemiology)|incidence]] and [[Mortality rate|mortality]] of [[tuberculosis]]; a vaccine that is effective in adult individuals who have not yet been infected with [[mycobacterium tuberculosis]], in addition to in those with latent [[mycobacterium tuberculosis]] infection.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO &#124; Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*This new novel vaccine will also offer the best chance to contain the accelerating spread of multi-drug resistant tuberculosis.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO &#124; Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*This new novel [[vaccine]] will also provide the best way to counteract accelerating spread of [[Multi-drug-resistant tuberculosis|multi-drug resistant tuberculosis]].<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO &#124; Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*To this date, this new vaccine has not been developed but many TB vaccine candidates are in pipeline.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO &#124; Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*To this date, this new vaccine has not been developed but many [[Tuberculosis|TB]] [[vaccine]] candidates are in pipeline.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO &#124; Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*Potential vaccines are either whole-cell vaccines, adjuvanted proteins, and vectored subunit vaccines.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO &#124; Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*Potential vaccines are either whole-cell vaccines, adjuvanted proteins, and vectored subunit vaccines.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO &#124; Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*Up till now, there was no communicated consensus as to the preferred product characteristics (PPC) that would adequately support favorable policy recommendations for implementation where needed.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO &#124; Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*A document highlighting [[World Health Organization|WHO]] preferred Product Characteristics (PPC) for new TB vaccines has been devised based on a high unmet medical need and technical feasibility assessment.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO &#124; Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*A document highlighting WHO preferred Product Characteristics (PPC) for new TB vaccines has been devised based on a high unmet medical need and technical feasibility assessment.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO &#124; Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*The vaccine PPCs are built through a large consensus building process and originate from interactions with different stakeholders.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO &#124; Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*The preferred product characteristics (PPC) describe WHO preferences for parameters of vaccines, in particular their indications, target groups, possible immunization strategies, and features of clinical data desired related to safety and efficacy, supportive of policy decision making.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO &#124; Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*The vaccine PPCs are built through a wide consensus building process and result from interactions with a variety of stakeholders.<ref name="urlWHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT">{{cite web |url=https://www.who.int/immunization/research/development/tuberculosis/en/ |title=WHO &#124; Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT |format= |work= |accessdate=}}</ref>
*The new vaccine, made by GSK and now known as M72/AS01E, was tested in about 3,300 adults in Kenya, South Africa, and Zambia.
*The new vaccine, made by GSK and now known as M72/AS01E, was tested in about 3,300 adults in Kenya, South Africa, and Zambia.
*All of them already had latent tuberculosis, Of those who got two doses of the GSK vaccine, only 13 developed active tuberculosis during three years of follow-up, according to the new study published in The New England Journal of Medicine. By contrast, 26 of those who got a placebo progressed to active tuberculosis.
*All of them already had latent [[tuberculosis]], Of those who got two doses of the GSK vaccine, only 13 developed active [[tuberculosis]] during three years of follow-up, according to the new study which was published in The New England Journal of Medicine. On the other hand, 26 of those who received a [[placebo]] progressed to active tuberculosis.


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Latest revision as of 05:47, 27 March 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Mashal Awais, M.D.[2]; Ammu Susheela, M.D. [3] ; Marjan Khan M.B.B.S.[4]

Overview

With emergence of new drug-resistant tuberculosis, the role of future therapies is crucial in curbing outbreaks. The new drugs should be more effective than the current regimen and a few drugs in clinical trials have been showing promising results.

Future investigations

Principles of future investigations

Any future regimen must fulfill the following recommendations: [1]

  • It should not have more than a maximum duration of 6 months
  • The dosing schedule must be simple
  • The ideal number of drugs should not exceed 3-5 drug from a different class
  • It should have a minimum side effect profile so that we could have minimum monitoring
  • It should be effective against MDR, XDR, and XXDR strains
  • It should be administered orally
  • It should have minimum interaction with antiretroviral drugs.
  • It should have at least one new class of drug

New drugs involved in a clinical trial for the treatment of tuberculosis

Drug Phase Class
Moxifloxacin Phase III Fluoroquinolone
Linezolid Phase II Oxazolidinone
AZD-5847 Phase II Oxazolidinone
Sutezolid Phase II Oxazolidinone
Clofazimine Phase II Riminophenazine
SQ-109 Phase II Ethylenediamine
PA-824 Phase IIb Nitroimidazole
Delamanid Phase III Nitroimidazole
Bedaquiline Phase III Diarylquinoline
Data provided by WHO[2]

Tuberculosis vaccine development

  • Neonatal BCG vaccination is partially effective at protecting infants and children, especially from the most severe complications of TB disease.[3]
  • BCG is poorly effective at protecting against pulmonary disease in adults, and hence at decreasing Mycobacterium tuberculosis transmission.[3]
  • A new novel vaccine is needed to reduce the incidence and mortality of tuberculosis; a vaccine that is effective in adult individuals who have not yet been infected with mycobacterium tuberculosis, in addition to in those with latent mycobacterium tuberculosis infection.[3]
  • This new novel vaccine will also provide the best way to counteract accelerating spread of multi-drug resistant tuberculosis.[3]
  • To this date, this new vaccine has not been developed but many TB vaccine candidates are in pipeline.[3]
  • Potential vaccines are either whole-cell vaccines, adjuvanted proteins, and vectored subunit vaccines.[3]
  • A document highlighting WHO preferred Product Characteristics (PPC) for new TB vaccines has been devised based on a high unmet medical need and technical feasibility assessment.[3]
  • The vaccine PPCs are built through a large consensus building process and originate from interactions with different stakeholders.[3]
  • The new vaccine, made by GSK and now known as M72/AS01E, was tested in about 3,300 adults in Kenya, South Africa, and Zambia.
  • All of them already had latent tuberculosis, Of those who got two doses of the GSK vaccine, only 13 developed active tuberculosis during three years of follow-up, according to the new study which was published in The New England Journal of Medicine. On the other hand, 26 of those who received a placebo progressed to active tuberculosis.


References

  1. "Future therapy purposed by WHO".
  2. "Tuberculosis (TB) Future drugs".
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 "WHO | Tuberculosis vaccine development, SYSTEM DO NOT MOVE OR EDIT".

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