New Tuberculosis treatment could save millions of lives

Monday 20 February 2023

World-leading scientists from the University of St Andrews reveal a new Tuberculosis (TB) therapeutics that could shorten the treatment of the disease by up to two months, potentially saving millions of lives.

Dr Muge Cevik, a clinical academic in infectious diseases and medical virology based in the Infections and Global Health Research Division of the School of Medicine at St Andrews, will deliver the results of the worldwide TB Alliance’s SimpliciTB clinical trial at the 30th annual Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle today (Monday 20 February). Bringing together the most respected infectious disease healthcare professionals and scientists from around the globe to discuss human retroviruses and other relevant infections such as TB and SARS-CoV-2 (Covid-19), CROI is one of the world’s most prestigious congresses in this field.

Tuberculosis causes about a million deaths every year. To change this and save lives, new tools and new treatments are required. Active TB must be treated with a combination of drugs; the most drug-sensitive forms of TB require at least four months of treatment using four anti-TB drugs. According to the World Health Organization (WHO) an estimated 1.6 million people died of TB in 2021, although the precise numbers are not known and recent research suggests that TB could have killed many more people.

The international SimpliciTB trial was conducted to evaluate the BPaMZ regimen, consisting of bedaquiline (B), pretomanid (Pa), moxifloxacin (M), and pyrazinamide (Z). This combination previously showed high efficacy and treatment shortening potential in both preclinical evaluations and an early-stage clinical study in drug resistant patients.

SimpliciTB enrolled 455 patients with drug-susceptible (DS) or drug-resistant (DR) tuberculosis (TB) at 26 sites across eight countries: South Africa, Tanzania, Georgia, Brazil, Russia, the Philippines, Uganda, and Malaysia. The clinical trial was designed to evaluate the safety and efficacy of BPaMZ in patients with either DS-TB or DR-TB. As will be presented at CROI, the results of the trial showed that the BPaMZ regimen was highly potent against the TB bacteria, meeting its primary endpoint with DS-TB participants 2.93 times more likely to culture convert by week eight. However, the four-month experimental BPaMZ regimen did not meet the secondary endpoint of noninferiority in percent favourable outcomes compared to six months of HRZE in DS-TB. This was due to adherence challenges, with approximately ten percent of patients on the BPaMZ arms discontinuing treatment due to side effects.

“Recent progress in tuberculosis therapeutics has been limited, with few new drug classes emerging in the last 50 years,” said Dr Cevik, adding: “Innovative clinical trials like SimpliciTB help us better understand how novel drug regimens work against both drug-sensitive and drug-resistant TB, lighting the way to better treatment options for all TB patients.”

In 2021, ten million people were infected with TB and about 1.6 million people died. It is estimated that about 500,000 people every year are infected by a drug-resistant form of the disease, and in some regions as many as 40 percent of all cases are drug resistant. Novel drug regimens are urgently needed to help bring the TB pandemic under control. Drug-resistant TB develops when the long, complex, decades-old TB drug regimen is improperly administered, or when people contract TB from others who have drug-resistant disease – highlighting the urgent need to develop better and shorter treatment regimens. Only an estimated one third of people with drug-resistant TB infections received treatment in 2021.

The Infection and Global Health Research Division at the University of St Andrews works in a wide range of fields that includes clinical trials, genetics, anti-microbial resistance, diagnostic tools, education, and global health policy. Professor Stephen Gillespie, leader of the infection group at St Andrews, said: “This study shows the value of St Andrews world-leading partnership working with international collaborators and the TB Alliance. Together, we have a sustained commitment to develop new and better treatments for tuberculosis which remains a threat to human health globally.”

Dr Derek Sloan, Reader in the School of Medicine involved in the global trial added: “The trial suggests that new antibiotic combinations can kill all types of TB bacteria faster than traditional approaches, which is exciting. However, as we find new options to improve TB treatment, we still need to work out which therapies are most suitable for each individual patient. Future work will include more detailed investigation of which anti-TB antibiotics work best together. Future considerations will include patient safety and the complex logistics of how to implement new treatment strategies across the diverse range of settings where TB is a major threat to health, worldwide.”

The TB Alliance plans to submit data from SimpliciTB to a peer-reviewed publication. The TB Alliance is a not-for-profit organisation dedicated to the discovery, development and delivery of better, faster-acting and affordable tuberculosis drugs that are available to those who need them.

The research by the Infection Group at St Andrews is supported and funded from the European Developing Countries Clinical Trials Partnership (EDCTP).

Presentation and Conference

The presentation of the clinical trial will be available online (6pm GMT)

 The Conference programme is available online.

About TB Alliance

TB Alliance is a not-for-profit organisation dedicated to finding faster-acting and affordable drug regimens to fight TB. Through innovative science and with partners around the globe, we aim to ensure equitable access to faster, better TB cures that will advance global health and prosperity.

TB Alliance operates with support from Australia’s Department of Foreign Affairs and Trade; the Bill & Melinda Gates Foundation; the Foreign, Commonwealth and Development Office (United Kingdom); the Cystic Fibrosis Foundation; Germany’s Federal Ministry of Education and Research through KfW; the Global Disease Eradication Fund (South Korea), the Global Health Innovative Technology Fund; the Indonesia Health Fund; Irish Aid; the Korea International Cooperation Agency; the Medical Research Council (United Kingdom); the National Institute of Allergy and Infectious Diseases; Netherlands Ministry of Foreign Affairs; South Korea’s Ministry of Foreign Affairs; the United Kingdom Department for International Development; and the United States Agency for International Development. SimpliciTB was funded in part by the European & Developing Countries Clinical Trials Partnership (EDCTP) through a grant to the TB research team at the University of St Andrews.

Issued by the University of St Andrews Communications Office.

Category Research

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