Bedaquiline and TB: What might the future hold?

A 最准的六合彩论坛-TB / Africa Health Research Institute event to discuss the rollout of bedaquiline for TB treatment

听Friday 30th July, 11.00-13.30pm UK time; 10.00-12.30pm SA time

After decades without new drugs for TB, there are now more options. Bedaquiline (BDQ) has changed the TB treatment landscape as the first of these new drugs to be licensed for drug-resistant TB. Recent high profile clinical trials which included BDQ have shown efficacy with few adverse events against MDR/XDR TB, and in shorter regimens for drug-sensitive TB. For the first time in many years, the future looks bright.

However, there are warning clouds on the horizon. Resistance to BDQ is already present and capacity to detect it is limited. There is tension between the need for the manufacturers to recoup the costs of development, the ability of those in need to be able to afford it, and the global community鈥檚 responsibility to ensure that it's effective for as long as possible for the most resistant cases. How does a clinician balance the needs of one patient with those of the population? Should it be used for NTM infections for which there is limited evidence, but few or no alternative options? What (expensive and lengthy) clinical trials should we embark on for the best outcome? Considering the risks around resistance, what is the place of bedaquiline in TB preventive therapy?

All these questions are already being aired, and will only become more pertinent as time goes by. We therefore thought that now is a good time to discuss them. This will be a facilitated workshop that aims to present (a) the current situation; (b) possible future scenarios; and (c) a discussion by people in the field with different perspectives including TB survivors, policy, and research, not only for BDQ, but also for new drugs that may emerge.

T锘縣is expert panel discussion is co-organised by 最准的六合彩论坛-TB and the Africa Health Research Institute (AHRI;听). We would encourage anyone with an interest in TB to join us for this event to be a part of what promises to be an informative discussion tackling one of the biggest issues in the field today.

Organizing committee: Conor Tweed (最准的六合彩论坛), Helgard Claassen (AHRI), Hannah Keal (AHRI), Al Leslie (AHRI), Emily Shaw (最准的六合彩论坛), Neil Stoker (最准的六合彩论坛)

Speaker affiliations: see below

础锘縢别苍诲补

1锘�1:00-11:10 (all timings BST)

W锘縠lcome and introduction听Limakatso Lebina (AHRI) and Marc Lipman (最准的六合彩论坛)

1锘�1:10 -12:00

W锘縣at do we know?听Short presentations on the state of current knowledge:

Patient perspective (Oxana Rucsineanu, TB survivor, Society of Moldova against Tuberculosis)
Patient perspective (Phumeza Tisile, TB survivor, Advocacy Officer, TB Proof, South Africa)
BDQ Resistance (Grant Theron, Stellenbosch University, South Africa)
Clinical Practice (Lancelot Pinto, P.D.Hinduja National Hospital and Medical Research Centre, Mumbai, India)
Trials/Future Directions (Francesca Conradie, University of the Witwatersrand, South Africa)
Policy (Teck Chuan Voo, National University, Singapore)

12:00-1320

What might the future be?听The speakers (above) and panellists listed below will discuss a series of questions:

BDQ Resistance (Rob Warren, Stellenbosch University, South Africa)
Clinical Practice (Chen-Yuan Chiang, Taipei Medical University, Taiwan)
Trials/Future Directions (Derek Sloan, University of St Andrews, UK)
Policy (Christoph Lange, University of L眉beck, Germany)

1锘�315-1330

厂锘縰尘尘补谤测

N锘縪te that details may change. T锘縣e workshop will be recorded and made available online after the event.

Speaker affiliations and short biographies

Chen-Yuan Chiang (MD, MPH, Dr Philos, Professor, Division of Pulmonary Medicine, Taipei Medical University, Taiwan; Senior Consultant, The Union)听
Professor Chiang is a clinician, specialized in respiratory and critical care medicine, obtained the degree of MPH at UC- Berkeley, US and DrPhilos at University of Bergen, Norway. He has been working with the International Union Against Tuberculosis and Lung Disease (The Union), Paris, France as an international consultant since 2003. Currently, he is Director, Department of Medical Research, Wan Fang Hospital, Taipei Medical University; Professor, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University; and Technical Advisory Group on Tuberculosis (TB TAG) in the Western Pacific Region, World Health Organization听听

Francesca Conradie (School of Clinical Medicine, University of the Witwatersrand, South Africa)听
Dr Francesca Conradie leads a clinical unit dedicated to improving the diagnosis and treatment outcomes for both drug sensitive and drug resistant TB through clinical research and translation of research findings in national and international policy. She has had a key role in developing evidence for the safe and effective use of Bedaquiline in TB treatment, being the Principal Investigator for the TB Alliance NiX trial, which led to the registration by the FDA of BPaL, and its successor trial ZeNix. She heads the operational research introducing BPaL into the South African National TB Programme.听

Christoph Lange (Professor of Respiratory Medicine and International Health, University of L眉beck, Germany; Director & Secretary General, The Union)

Christoph Lange is the Medical Director of the Research Center Borstel, Leibniz-Lung Center, Germany, and the Head of the Clinical Tuberculosis Unit at the听 German Center for Infection Research (DZIF). His scientific work focuses on drug-resistant tuberculosis and personalized medicine. He is the clinical co-lead of UNITE4TB, an international consortium for the evaluation of novel anti-tuberculosis medicines in clinical phase II studies.

Lancelot Pinto (Consultant Pulmonologist at the P.D.Hinduja Hospital and Medical Research Centre, Mumbai, India听)
Dr Pinto is a clinician researcher with an interest in TB diagnostics and treatment. He has a Masters in Epidemiology from McGill University, where his research included validating radiological scoring systems for the diagnosis of TB (in collaboration with the University of Cape Town). He has consulted for the World Health Organization and USAID, and has a keen interest in knowledge translation and the practice of evidence-based medicine. His areas of interest include the management of drug-resistant tuberculosis, chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea. He is actively involved in a private-public partnership for the care of patients with drug-resistant TB, and is a member of the executive committee of the state anti-Tuberculosis Association. He is a proponent of preventive respiratory care 鈥� smoking cessation, focusing on air quality/ventilation, and strategies to improve respiratory health have been key focus areas.听

Oxana Rucsineanu (Executive Director, Society of Moldova against Tuberculosis (SMIT) Association, Moldova; TB Global CAB member)
Oxana Rucsineanu has a Master鈥檚 degree in Public Health. Oxana is leading SMIT TB organization in Moldova, which provides psychosocial support, peer education and activities to end stigma, coordinating several projects focusing on the rights of TB people, comprehensive approaches to TB care and engaging communities in research and development. She is strongly committed to advocating for constructive partnerships and efficient treatment processes as well as to making TB voices heard in the global TB response. She is an active member of the different TB national platforms and committees in the country. Internationally, Oxana is engaged in various TB community forums, including TB CAB, TBEC, GCTA, TB People etc.听

Derek Sloan (Reader/Consultant in Infectious Diseases, School of Medicine, University of St Andrews, UK)
Dr Sloan is an Infectious Diseases physician working at the University of St Andrews and in NHS Fife. His interests include clinical trials of new treatments for tuberculosis, collaborating with partners from the PanAfrican Consortium for the Evaluation of Anti-tuberculosis Antibiotics (PanACEA) and the global TB Alliance. He has worked on TB Control in England and Scotland, and in several African countries (Kenya, South Africa, Malawi and Uganda). He contributes to the British Thoracic Society MDR-TB clinical advisory service and to Scotland鈥檚 multi-disciplinary TB network.听

Phumeza Tisile (Advocacy Officer, TB Proof, South Africa)
Phumeza Tisile was diagnosed with TB in 2010 aged 20 and was forced to stop her studies at Cape Peninsula University of Technology to go for treatment. Five months of treatment, first for drug-sensitive TB and then for multidrug-resistant TB were ineffective, and she was finally diagnosed with extensively drug-resistant TB. This led to complex treatment of taking 30 tablets a day and an injection, followed by 2 years of hospitalisation and loss of hearing for 5 years. Her research is now focused on the immediate and long-term impacts of being a TB patient and survivor including managing stigmatisation, disability and mental health conditions.

Grant Theron (Professor of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa听)
Professor Grant Theron is Principal Investigator of the Clinical Mycobacteriology and Epidemiology (CLIME) Group at Stellenbosch University, which focuses on improving how patients with TB or drug-resistant TB are diagnosed, enhancing our understanding of TB transmission, and investigating whether the microbiome has any role in TB pathogenesis. He was part of the team that demonstrated the practicability of the Xpert molecular diagnostic platform, informing WHO recommendations on its use, as well as identifying limitations in practice, due to the clinicians鈥� treatment choices being only partly based on diagnostic results 鈥� emphasising the importance of understanding the context in which diagnostic tests are used.听

Voo Teck Chuan (Assistant Professor, Centre for Biomedical Ethics, National University of Singapore)
Trained in Philosophy and Medical Jurisprudence, Dr VOO Teck Chuan is Assistant Professor at the Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore. He researches on healthcare ethics and the ethics of infectious disease control and prevention, with focus on emergency situations. He is on the Ethics Advisory Board for UNITE4TB, a consortium that is delivering novel phase 2 clinical trials in about 40 trial sites on four continents to accelerate the development of new TB drugs and regimens. Teck Chuan has served the WHO in various capacities in the development of clinical guidelines, and ethics guidance relating to epidemics and public health emergencies.听

Rob Warren听(Professor and Director, SAMRC Centre for Tuberculosis Research Unit, Stellenbosch University, South Africa)
Professor Robin Warren is the Unit Director of the South African Medical Research Council Centre for Tuberculosis Research and Distinguished Professor at Stellenbosch University. He also heads the TB Genomics research group in the Division of Molecular Biology and Human Genetics in the Faculty of Medicine and Health Sciences. Prof Warren has co-authored over 400 papers in the field of Tuberculosis. Critical questions currently under investigation include using whole genome sequencing in combination with microbiological methods to determine associations between genotype and drug resistance phenotype, genome sequence variation and virulence and transmission, and targeted deep sequence to identify 鈥減re-resistance鈥�.听