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Bedaquiline: how better to use it

Jose A. Caminero, Alberto Piubello, Anna Scardigli, Giovanni Battista Migliori
European Respiratory Journal 2017 50: 1701670; DOI: 10.1183/13993003.01670-2017
Jose A. Caminero
1Pneumology Dept, Hospital General de Gran Canaria “Dr. Negrin”, Las Palmas de GC, Spain
2Tuberculosis Division, International Union against Tuberculosis and Lung Disease (The Union), Paris, France
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Alberto Piubello
2Tuberculosis Division, International Union against Tuberculosis and Lung Disease (The Union), Paris, France
3MDR-TB Division, Damien Foundation, Brussels, Belgium
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Anna Scardigli
4The Global Fund to Fight Aids, Tuberculosis and Malaria, Geneva, Switzerland
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Giovanni Battista Migliori
5Maugeri Care and Research Institute, IRCCS, Tradate, Italy
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  • ORCID record for Giovanni Battista Migliori
  • For correspondence: giovannibattista.migliori@icsmaugeri.it
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Abstract

Reflections on the best possible use of bedaquiline http://ow.ly/JiFL30fBZaQ

From the authors:

We read with interest the correspondence by J. Furin and co-workers and we wish to thank them for their useful comments on our editorial proposing a rationale for a standardised regimen to manage difficult-to-treat cases affected by extensively drug-resistant tuberculosis (XDR-TB) or by so-called pre-extensively drug-resistant tuberculosis (pre-XDR; multidrug-resistant tuberculosis (MDR-TB) cases with additional resistance to fluoroquinolones or second-line injectable drugs) [1]. We agree with the comments by Furin and co-workers and the arguments discussing the possible use of the new drugs (bedaquiline and/or delamanid) for more than 6 months. Clinicians know very well how difficult it is to manage the treatment of these cases in view of their clinical complexity (with frequent adverse events), long duration and high cost [2–4]. Considering the new perspectives for treating MDR-TB and XDR-TB we fully agree that we are presently facing exciting times. We finally have a couple of new and repurposed drugs and we are slowly discovering how best to use them, as well as how effective and safe they are [4–7]. The necessary body of knowledge to support evidence-based recommendations will need time to be raised and this is reflected by the increase in new proposals and recommendations being issued [8, 9]. Among the different ingredients for a potential, future standardised regimen for MDR/XDR-TB cases, the biological plausibility of the core drugs to be used (bactericidal and sterilising) is particularly important (table 1) [1]. As both bedaquiline and delamanid have excellent characteristics, both their prolonged and/or combined use will be challenges that will need to be faced in the future. Slowly but surely new evidence is becoming available [2, 3] and we are confident that, given the high morbidity and mortality caused by MDR/XDR-TB, as well as the collaborative spirit animating clinicians, public health officers, policy makers, donors and members of the affected communities, better evidence will be raised to always ensure that the patient is adequately protected. Finally, the “off-label” use of drugs is sometimes necessary to manage patients for whom no other alternatives exist. Their use requires adequate capacity in terms of clinical expertise, laboratory support and infection control measures. We therefore hope that our proposal will soon be supported by the necessary evidence so as to be useful, safe and effective.

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TABLE 1

Characteristics of the drugs used to treat multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis

Footnotes

  • Conflict of interest: None declared.

  • Received August 17, 2017.
  • Accepted August 17, 2017.
  • Copyright ©ERS 2017

References

  1. ↵
    1. Caminero JA,
    2. Piubello A,
    3. Scardigli A
    , et al. Proposal for a standardised treatment regimen to manage pre- and extensively drug-resistant tuberculosis cases. Eur Respir J 2017; 50: 1700648.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Pontali E,
    2. Sotgiu G,
    3. D'Ambrosio L
    , et al. Bedaquiline and multidrug-resistant tuberculosis: a systematic and critical analysis of the evidence. Eur Respir J 2016; 47: 394–402.
    OpenUrlAbstract/FREE Full Text
  3. ↵
    1. Pontali E,
    2. D'Ambrosio L,
    3. Centis R
    , et al. Multidrug-resistant tuberculosis and beyond: an updated analysis of the current evidence on bedaquiline. Eur Respir J 2017; 49: 1700146.
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Borisov SE,
    2. Dheda K,
    3. Enwerem M
    , et al. Effectiveness and safety of bedaquiline-containing regimens in the treatment of MDR- and XDR-TB: a multicentre study. Eur Respir J 2017; 49: 1700387.
    1. Tiberi S,
    2. Payen MC,
    3. Sotgiu G
    , et al. Effectiveness and safety of meropenem/clavulanate-containing regimens in the treatment of MDR- and XDR-TB. Eur Respir J 2016; 47: 1235–1243.
    OpenUrlAbstract/FREE Full Text
    1. Tiberi S,
    2. Sotgiu G,
    3. D'Ambrosio L
    , et al. Comparison of effectiveness and safety of imipenem/clavulanate- versus meropenem/clavulanate-containing regimens in the treatment of MDR- and XDR-TB. Eur Respir J 2016; 47: 1758–1766.
    OpenUrlAbstract/FREE Full Text
  5. ↵
    1. Dalcolmo M,
    2. Gayoso R,
    3. Sotgiu G
    , et al. Effectiveness and safety of clofazimine in multidrug-resistant tuberculosis: a nationwide report from Brazil. Eur Respir J 2017; 49: 1602445.
    OpenUrlAbstract/FREE Full Text
  6. ↵
    1. Caminero JA,
    2. Scardigli A
    . Classification of antituberculosis drugs: a new proposal based on the most recent evidence. Eur Respir J 2015; 46: 887–893.
    OpenUrlAbstract/FREE Full Text
  7. ↵
    1. Falzon D,
    2. Schünemann HJ,
    3. Harausz E
    , et al. World Health Organization treatment guidelines for drug-resistant tuberculosis, 2016 update. Eur Respir J 2017; 49: 1602308.
    OpenUrlAbstract/FREE Full Text
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Bedaquiline: how better to use it
Jose A. Caminero, Alberto Piubello, Anna Scardigli, Giovanni Battista Migliori
European Respiratory Journal Nov 2017, 50 (5) 1701670; DOI: 10.1183/13993003.01670-2017

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Bedaquiline: how better to use it
Jose A. Caminero, Alberto Piubello, Anna Scardigli, Giovanni Battista Migliori
European Respiratory Journal Nov 2017, 50 (5) 1701670; DOI: 10.1183/13993003.01670-2017
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