The document summarizes TB treatment goals, current standards of care, and future prospects. It discusses the goals of TB treatment being to reduce adverse events, limit drug resistance, and properly use medications. The state of the art includes an all-oral 17-week treatment for drug-susceptible TB and an all-oral treatment including pretomanid, bedaquiline, and linezolid for multidrug-resistant TB. The future of TB treatment may include more decentralized and outpatient care through further development of all-oral regimens to improve patient quality of life and reduce costs.

1. TB treatment:
The Present and the Near Future
“StopTB DAY – Ritorno al futuro”
Pavia, 25 Marzo 2022
Niccolò Riccardi

2. • No conflict of interest to declare.

3. OUTLINE
• The goals of TB treatments
• State of the art of TB treatments
• A quick view on the future of TB treatments

4. TERAPIA ANTITUBERCOLARE RAGIONATA
Ridurre eventi avversi; limitare le resistenze; ridurre uso
inappropriato di farmaci; experts’ opinion
(Villa Marelli/Sondalo)
TREATMENT OUTCOME
COLLECTION
Data collection and sharing;
notifica di malattia, inizio e fine terapia;
INPS
TERAPIA ANTITUBERCOLARE
INDIVIDUALIZZATA
Whole genome sequencing; therapeutic drug
monitoring; all oral quando possibile;
aderenza alle linee guida
POSSIBILITA’ DI
CONFRONTO CON ALTRI
PAZIENTI
StopTB ti ascolta
AUMENTARE ADERENZA ALLA
TERAPIA
Sms/Wup reminder; ridurre i costi
delle visite; ridurre il burden
terapeutico
MIGLIORARE
LA QUALITA’
DI VITA DEI
NOSTRI
PAZIENTI

5. https://www.tballiance.org/
ECDC/WHO

6. MSF TB manifesto

9. OUTLINE
• The goals of TB treatments
• State of the art of TB treatments
• A quick view on the future of TB treatments

10. DS-TB
Nahid P et al. Executive Summary: Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical
Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis. Clin Infect Dis. 2016 Oct 1;63(7):853-67. doi: 10.1093/cid/ciw566.

11. DS-TB
• 8 weeks of once-daily rifapentine (1200 mg, within 1h
of food ingestion), isoniazid, pyrazinamide, and
moxifloxacin (400 mg)
followed by
• 9 weeks of once-daily rifapentine (1200 mg, within 1h
of food ingestion), isoniazid, and moxifloxacin (400 mg).
Open-label, phase 3, randomized, controlled trial involving persons with
newly diagnosed pulmonary tuberculosis from 13 countries

13. N Engl J Med 2021; 384:1705-1718 DOI: 10.1056/NEJMoa2033400

16. DR-TB

20. WHY ALL ORAL?
SCALE UP OF MDR-TB THROUGH DECENTRALIZED CARE
OUTPATIENT TREATMENTS
REDUCED PATIENTS DISCONFORT
LESS SIDE EFFECTS
REDUCED MONITORING
Milstein M. et al. (Re)moving the needle: prospects for all-oral treatment for multidrug-resistant tuberculosis; INT J TUBERC LUNG DIS 20(12):S18–S23

21. Pretomanid, a nitroimidazooxazine that inhibits
mycolic acid biosynthesis and thereby blocks
mycobacterial cell-wall production, also acts as a
respiratory poison against non-replicating bacteria
after nitric oxide release under anaerobic conditions

22. https://www.ecdc.europa.eu/sites/default/files/documents/tuberculosis-
surveillance-monitoring-Europe-2021.pdf

23. • A standard of care including more hospitalisation time in all these settings would
result in higher savings following the introduction of BPaL.

24. OUTLINE
• The goals of TB treatments
• State of the art of TB treatments
• A quick view on the future of TB treatments

26. BMJ 2020;368:m216

27. Courtesy of Ilaria Motta

28. Courtesy of Ilaria Motta
mITT=All participants assigned a randomisation number and dispensed study medication on at least one
occasion excluding participants who had sputum culture negative and/or rifampicin sensitive* at inclusion.

29. Courtesy of Ilaria Motta

31. Ringraziamenti
a tutto il personale sanitario, ai
pazienti e ai loro famigliari
Paola F Castellotti
Luigi R Codecasa
Maurizio Ferrarese
Giorgio Besozzi
Riccardo Alagna
Giovanni Sotgiu
Laura Saderi
Daniela Cirillo
Zarir Udwadia
Saverio De Lorenzo
Piero Viggiani
Marco Falcone
Francesco Menichetti
Giusy Tiseo
Lorenzo Suardi
Laura Rindi