BMJ 2015;350:h1518 doi: 10.1136/bmj.h1518 (Published 18 March 2015)
Page 1 of 1
Research News
RESEARCH NEWS New drug combination may shorten tuberculosis treatment, study says Susan Mayor London
A new combination drug regimen is more effective at reducing levels of the bacterium that causes tuberculosis than standard treatment and acts more quickly, an initial short term study has found.
The study randomised 207 patients with drug susceptible pulmonary tuberculosis to receive the new combination of pretomanid (either 100 mg or 200 mg), an antibiotic with a novel mode of action against Mycobacterium tuberculosis, moxifloxacin, and pyrazinamide (PaMZ) or standard treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol.1 Patients were treated and followed-up for eight weeks at eight sites in South Africa and Tanzania.
Nearly twice as many patients treated with the new combination (with 200 mg pretomanid) had no M tuberculosis in their sputum at the end of the two month trial as those given standard treatment (71.4% v 37.8%; hazard ratio 1.9 (95% confidence interval 1.19 to 3.00)). The bactericidal activity of the novel regimen, measured as the mean daily reduction in M tuberculosis colony forming units per mL of overnight sputum collected once a week, was 0.155 (95% Bayesian credibility interval 0.133 to 0.178), compared with 0.112 (0.093 to 0.131) for standard treatment. Researchers also investigated the drug combination (200 mg pretomanid) in a group of 26 patients with multidrug resistant
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tuberculosis and found an improved response similar to that in drug susceptible patients. Side effects with the new regimen included hyperuricaemia, nausea, and vomiting, but no patients had disturbances in heart rhythm.
“The results of this trial show the potential for the PaMZ regimen to improve treatment for tuberculosis,” said lead author Rod Dawson, head of the Centre for TB Research Innovation at the University of Cape Town, South Africa. “Especially noted is the fact that PaMZ may have a unique application as a potentially shorter, injection free regimen for a select subgroup of patients with multidrug resistant TB.”
The new regimen will now be tested in phase III trials in patients with drug susceptible and multidrug resistant tuberculosis, with the goal of shortening and simplifying treatment. 1
Dawson R, Diacon AH, Everitt D, et al. Efficiency and safety of the combination of moxifloxacin, pretomanid (PA-824), and pyrazinamide during the first 8 weeks of antituberculosis treatment: a phase 2b, open-label, partly randomised trial in patients with drug-susceptible or drug-resistant pulmonary tuberculosis. Lancet 18 Mar 2015, doi:10. 1016/S0140-6736(14)62002-X.
Cite this as: BMJ 2015;350:h1518 © BMJ Publishing Group Ltd 2015
Subscribe: http://www.bmj.com/subscribe
Page 1 of 1
Research News
RESEARCH NEWS New drug combination may shorten tuberculosis treatment, study says Susan Mayor London
A new combination drug regimen is more effective at reducing levels of the bacterium that causes tuberculosis than standard treatment and acts more quickly, an initial short term study has found.
The study randomised 207 patients with drug susceptible pulmonary tuberculosis to receive the new combination of pretomanid (either 100 mg or 200 mg), an antibiotic with a novel mode of action against Mycobacterium tuberculosis, moxifloxacin, and pyrazinamide (PaMZ) or standard treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol.1 Patients were treated and followed-up for eight weeks at eight sites in South Africa and Tanzania.
Nearly twice as many patients treated with the new combination (with 200 mg pretomanid) had no M tuberculosis in their sputum at the end of the two month trial as those given standard treatment (71.4% v 37.8%; hazard ratio 1.9 (95% confidence interval 1.19 to 3.00)). The bactericidal activity of the novel regimen, measured as the mean daily reduction in M tuberculosis colony forming units per mL of overnight sputum collected once a week, was 0.155 (95% Bayesian credibility interval 0.133 to 0.178), compared with 0.112 (0.093 to 0.131) for standard treatment. Researchers also investigated the drug combination (200 mg pretomanid) in a group of 26 patients with multidrug resistant
For personal use only: See rights and reprints http://www.bmj.com/permissions
tuberculosis and found an improved response similar to that in drug susceptible patients. Side effects with the new regimen included hyperuricaemia, nausea, and vomiting, but no patients had disturbances in heart rhythm.
“The results of this trial show the potential for the PaMZ regimen to improve treatment for tuberculosis,” said lead author Rod Dawson, head of the Centre for TB Research Innovation at the University of Cape Town, South Africa. “Especially noted is the fact that PaMZ may have a unique application as a potentially shorter, injection free regimen for a select subgroup of patients with multidrug resistant TB.”
The new regimen will now be tested in phase III trials in patients with drug susceptible and multidrug resistant tuberculosis, with the goal of shortening and simplifying treatment. 1
Dawson R, Diacon AH, Everitt D, et al. Efficiency and safety of the combination of moxifloxacin, pretomanid (PA-824), and pyrazinamide during the first 8 weeks of antituberculosis treatment: a phase 2b, open-label, partly randomised trial in patients with drug-susceptible or drug-resistant pulmonary tuberculosis. Lancet 18 Mar 2015, doi:10. 1016/S0140-6736(14)62002-X.
Cite this as: BMJ 2015;350:h1518 © BMJ Publishing Group Ltd 2015
Subscribe: http://www.bmj.com/subscribe
