Tuberculosis Treatment Trials

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Tuberculosis remains a major problem in many countries; in sub-Saharan Africa numbers of cases reported have increased dramatically following the advent of the HIV-AIDS epidemic. Treatment regimens for drug-sensitive tuberculosis which are highly effective under controlled trial conditions have been available for many years but need to be given for at least 6 months. Many patients fail to complete treatment since they feel much better after 2-3 months treatment. Shorter and simpler effective regimens are needed. The CTU recently completed two international multi-centre trials assessing the possibility of treatment shortening and/or simplifying treatment. A trial assessing ultra-short treatment has been funded and is planned to commence in the near future. There is an urgent need to find effective treatments for multi-drug resistant tuberculosis (MDR-TB), current regimens are given for long durations, are toxic, expensive and results are generally poor. A large multi-centre trial is currently in progress which is assessing a promising regimen which has been developed in Bangladesh; the trial includes two regimens containing the first new tuberculosis drug to be licensed for about 50 years. There have been very few trials of tuberculosis treatment in children, one such trial in children with limited disease is expected to start soon and trials in drug-resistant tuberculosis and TB-meningitis are planned.