WHO report highlights need for new TB drugs

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 “An analysis of the antibacterial clinical development pipeline, including tuberculosis” finds development falling short especially for tuberculosis . . .

Report finds second-line treatment regimens for TB already compromised, evidence of increasing transmission of multi, extensively drug-resistant TB, while lack of economic incentives continue to stall new tuberculosis drug development . . .

When the World Health Organization drew up a list last March of the “12 bacteria that pose the greatest threat to human health,” for which new drugs were most urgently needed, but left off tuberculosis, TB treatment leaders and advocates urged the international agency to add the world’s leading infectious disease killer, responsible for a third of all deaths caused by resistance to antibiotic medicines.

“WHO: When you make a mistake, fix it,” former CDC head Dr. Tom Frieden tweeted back then.

The agency didn’t do that, but, a report released this week tells us, in its next step, to assess the current status of progress in finding new treatments for pathogens grown resistant to old ones, it broadened its scope of inquiry to include “these priority pathogens, Mycobacterium tuberculosis and Clostridium difficile.” The resulting report  ANTIBACTERIAL AGENTS IN CLINICAL DEVELOPMENT – An analysis of the antibacterial clinical development pipeline, including tuberculosis, shows advances towards new treatments for the resistant pathogens posing the greatest threats to health and modern medicine lagging — especially for tuberculosis.

The report lists five reasons why developing medicines to combat TB now is “a global priority for research and development” including, that as the most common and dangerous airborne pathogen tuberculosis causes 1.8 million deaths a year, drug resistant tuberculosis causes an estimated quarter million deaths, while treatments are complex, toxic, agonizing and ineffective. The disease is economically devastating as well, while investment in new drugs, at its lowest level since 2008, is “seriously” insufficient.

But the report notes, “despite the estimated 10.4 million new TB cases occurring worldwide in 2015,” and the widespread resistance to two of the most important first-line TB drugs . . . only seven new agents for TB are in clinical trials,” with four of those in the earliest stages of development, years away from delivery. This need is particularly great because treating tuberculosis requires multiple medicines given in concert, while the demand for combinations of drugs to treat TB serves as a further economic disincentive to pharmaceutical companies to invest in TB drug development.

And the report flags ethical challenges related to the limited treatment options  including isolating patients without their consent, not diagnosing patients because therapeutics are not available and failing to provide support to patients who have exhausted their treatment options without the prospect of being cured of tuberculosis.

But, the report notes, “For TB, a disease that affects mainly the poor, there is very little commercial incentive to invest in developing new treatments.”

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