Scientific advances and the end of tuberculosis: a report from the Lancet Commission on Tuberculosis

Reid, Michael; Agbassi, Yvan Jean Patrick; Arinaminpathy, Nimalan; Bercasio, Alyssa; Bhargava, Anurag; Bhargava, Madhavi; Bloom, Amy; Cattamanchi, Adithya; Chaisson, Richard; Chin, Daniel; Churchyard, Gavin; Cox, Helen; Denkinger, Claudia M; Ditiu, Lucica; Dowdy, David; Dybul, Mark; Fauci, Anthony; Fedaku, Endalkachew; Gidado, Mustapha; Harrington, Mark; Hauser, Janika; Heitkamp, Petra; Herbert, Nick; Herna Sari, Ani; Hopewell, Philip; Kendall, Emily; Khan, Aamir; Kim, Andrew; Koek, Irene; Kondratyuk, Sergiy; Krishnan, Nalini; Ku, Chu-Chang; Lessem, Erica; McConnell, Erin V; Nahid, Payam; Oliver, Matt; Pai, Madhukar; Raviglione, Mario; Ryckman, Theresa; Schäferhoff, Marco; Silva, Sachin; Small, Peter; Stallworthy, Guy; Temesgen, Zelalem; van Weezenbeek, Kitty; Vassall, Anna; Velásquez, Gustavo E; Venkatesan, Nandita; Yamey, Gavin; Zimmerman, Armand; Jamison, Dean; Swaminathan, Soumya; Goosby, Eric

doi:10.1016/s0140-6736(23)01379-x

Cited by 20 publications

(6 citation statements)

References 128 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This includes those in charge of designing and conducting research, but also those who will play a key role in the implementation of the innovations emerging from the trials. Past delays in transferring new tools from high-income countries capable of affording them to less economically developed countries have several explanations: problems with local registration, 1 10 11 need for testing locally, [12][13][14] lack of endorsement by entities such as WHO, 1 5 15 16 high price, [17][18][19] constraints in procurement and supply management, 5 20 21 limited manufacturing capacity, 4 22 23 as well as lack of awareness and false perceptions on potential adverse reactions and other complications. 24 25 Therefore, engaging key stakeholders from the first step of designing a clinical trial may facilitate and accelerate the future uptake of new TB regimens in any country, especially the low-income and middle-income countries (LMICs) with high TB burden.…”

Section: Bmj Global Healthmentioning

confidence: 99%

Towards comprehensive clinical trials for new tuberculosis drug regimens: policy recommendations from a stakeholder analysis

Villa,

de Colombani,

Dall’Olio

et al. 2024

BMJ Glob Health

Self Cite

View full text Add to dashboard Cite

BackgroundResearch and development (R&D) of new drugs and regimens against tuberculosis (TB) is evolving to meet new challenges and face limited investments in the sector. To effectively improve and fill existing gaps, researchers and trialists should engage a broad spectrum of stakeholders. With this study, we aim to map the interests in TB R&D raised by the main stakeholders in the TB field.MethodsWe conducted semistructured, short interviews to gather insight and viewpoints on innovation on TB drugs and regimens R&D of policy-makers, national TB programme officers, donors, funders, non-governmental organisations and research institutions.A composite measure of the relevance of topics that emerged was computed by implementing different models considering the importance for researchers and the urgency to implement those changes during the trial, the number of citations each topic received, and the maximum value of the influence of stakeholders who had raised the topic.Results50 stakeholders, out of 56 identified, were interviewed and almost half were policy-makers and governmental institutions. Several stakeholders highlighted the importance of disseminating information about clinical trials’ methodology and emerging preliminary results, followed by the need to pursue early discussion around access and pricing of safe and effective TB innovations, although different categories of stakeholders prioritised different topics. Using different methods for ranking topics, the results remained almost unchanged. Notably, post-trial operational research ranked higher in models with higher weight for the parameter considering the number of citations.ConclusionResearchers and research consortia embarking on phase 2 and 3 clinical trials should consider a broad set of elements when planning and designing trials’ protocols, all aiming at lowering the price and improving access to emerging TB innovations, besides meeting regulatory criteria. This can only be achieved by consulting and engaging relevant stakeholders in the discussion.

show abstract

Section: Bmj Global Healthmentioning

confidence: 99%

Towards comprehensive clinical trials for new tuberculosis drug regimens: policy recommendations from a stakeholder analysis

Villa,

de Colombani,

Dall’Olio

et al. 2024

BMJ Glob Health

Self Cite

View full text Add to dashboard Cite

show abstract

“…Hsu et al ( 14 ) observed an incidence rate of infectious complications of 16.8% (17/101) in adult NS patients, primarily pneumonia, cellulitis/fasciitis, and urinary tract infections, with one of the three deaths due to TB pneumonia. In the 5 years following the United Nations High-Level Meeting in 2018, over 7 million people died from TB globally, with an estimated 10.6 million people contracting TB in 2021 ( 2 , 15 ). The decision to use immunosuppressants in NS patients with TB infection is critical because TB infection, with its lengthy treatment duration, uncertain drug side effects, and resistance issues, may further complicate NS treatment.…”

Section: Introductionmentioning

confidence: 99%

A prediction model for prognosis of nephrotic syndrome with tuberculosis in intensive care unit patients: a nomogram based on the MIMIC-IV v2.2 database

Du,

Su,

et al. 2024

Front. Med.

View full text Add to dashboard Cite

BackgroundCurrently, a scarcity of prognostic research exists that concentrates on patients with nephrotic syndrome (NS) who also have tuberculosis. The purpose of this study was to assess the in-hospital mortality status of NS patients with tuberculosis, identify crucial risk factors, and create a sturdy prognostic prediction model that can improve disease evaluation and guide clinical decision-making.MethodsWe utilized the Medical Information Mart for Intensive Care IV version 2.2 (MIMIC-IV v2.2) database to include 1,063 patients with NS complicated by TB infection. Confounding factors included demographics, vital signs, laboratory indicators, and comorbidities. The Least Absolute Shrinkage and Selection Operator (LASSO) regression and the diagnostic experiment the receiver operating characteristic (ROC) curve analyses were used to select determinant variables. A nomogram was established by using a logistic regression model. The performance of the nomogram was tested and validated using the concordance index (C-index) of the ROC curve, calibration curves, internal cross-validation, and clinical decision curve analysis.ResultsThe cumulative in-hospital mortality rate for patients with NS and TB was 18.7%. A nomogram was created to predict in-hospital mortality, utilizing Alb, Bun, INR, HR, Abp, Resp., Glu, CVD, Sepsis-3, and AKI stage 7 days. The area under the curve of the receiver operating characteristic evaluation was 0.847 (0.812–0.881), with a calibration curve slope of 1.00 (0.83–1.17) and a mean absolute error of 0.013. The cross-validated C-index was 0.860. The decision curves indicated that the patients benefited from this model when the risk threshold was 0.1 and 0.81.ConclusionOur clinical prediction model nomogram demonstrated a good predictive ability for in-hospital mortality among patients with NS combined with TB. Therefore, it can aid clinicians in assessing the condition, judging prognosis, and making clinical decisions for such patients.

show abstract

“…Tuberculosis destroyed lung (TDL) is currently known as one of the most severe complications of pulmonary tuberculosis [ 1 , 2 ]. Despite the continuous release of new diagnostic and treatment guidelines by the World Health Organization for tuberculosis, there are still various factors such as uncontrollable multidrug-resistant pulmonary tuberculosis and severe drug reactions [ 3 – 6 ]. As a result, 40.3–66.7% of pulmonary tuberculosis patients may experience extensive lung structural changes, and approximately 1.3% of pulmonary tuberculosis patients progress to TDL [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Analysis of clinical characteristics of different types of lung function impaiement in TDL patients

Zhao,

Cao,

et al. 2024

BMC Pulm Med

View full text Add to dashboard Cite

Aim The clinical characteristics associated with pulmonary function decline in patients with Tuberculosis-destroyed lung (TDL) remain uncertain. We categorize them based on the pattern of pulmonary function impairment, distinguishing between restrictive spirometric pattern (RSP) and obstructive spirometric pattern (OSP). We aim to compare the severity of these patterns with the clinical characteristics of TDL patients and analyze their correlation. Method We conducted a retrospective analysis on the clinical data of TDL patients who underwent consecutive pulmonary function tests (PFT) from November 2002 to February 2023. We used the lower limit formula for normal values based on the 2012 Global Lung Function Initiative. We compared the clinical characteristics of RSP patients with those of OSP patients. The characteristics of RSP patients were analyzed using the tertiles of forced vital capacity percentage predicted (FVC% pred) decline based on PFT measurements, and the characteristics of OSP patients were analyzed using the tertiles of forced expiratory volume in 1 s percentage predicted (FEV1% pred) decline. Result Among the RSP patients, those in the Tertile1 group (with lower FVC% pred) were more likely to have a higher of body mass index (BMI), spinal deformities, and C-reactive protein (CRP) compared to the other two groups (P for trend < 0.001, 0.027, and 0.013, respectively). Among OSP patients, those in the Tertile1 group (with lower FEV1% pred) showed an increasing trend in cough symptoms and contralateral lung infection compared to the Tertile 2–3 group (P for trend 0.036 and 0.009, respectively). Conclusion For TDL patients, we observed that Patients with high BMI, a higher proportion of spinal scoliosis, and abnormal elevation of CRP levels were more likely to have reduced FVC. Patients with decreased FEV1% pred have more frequent cough symptoms and a higher proportion of lung infections on the affected side.

show abstract

Scientific advances and the end of tuberculosis: a report from the Lancet Commission on Tuberculosis

Cited by 20 publications

References 128 publications

Towards comprehensive clinical trials for new tuberculosis drug regimens: policy recommendations from a stakeholder analysis

Towards comprehensive clinical trials for new tuberculosis drug regimens: policy recommendations from a stakeholder analysis

A prediction model for prognosis of nephrotic syndrome with tuberculosis in intensive care unit patients: a nomogram based on the MIMIC-IV v2.2 database

Analysis of clinical characteristics of different types of lung function impaiement in TDL patients

Contact Info

Product

Resources

About