Riccardi Niccolò, Villa Simone, Alagna Riccardo, Giacomelli Andrea, Saderi Laura, Cirillo Daniela Maria, Besozzi Giorgio, Sotgiu Giovanni, Codecasa Luigi
StopTB Italia Onlus, Milan 20159, Italy.
Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona 37024, Italy.
Infect Drug Resist. 2020 Aug 11;13:2795-2800. doi: 10.2147/IDR.S257480. eCollection 2020.
The emerge of drug-resistant tuberculosis (TB) strain in recent decades is hampering the efforts of the international community to eliminate the disease worldwide. The World Health Organization (WHO) has drafted many strategies to achieve this ambitious goal. In the very beginning, the aim was to standardize inadequate regimens used in many countries and, thereafter, evolved to tackle the social determinants which hinder TB elimination. However, following the path of narrowing the clinical vision to deal with TB, there is an increased need to personalize the treatment considering both patients and pathogen unique characteristics. In our narrative review, we report the advantages and the backwards in developing a method to implement the concept of precision medicine to the treatment of TB. In this dissertation, we highlight the importance to address different aspects of the diseases encompassing the host and pathogen features, as well as the needs to further implement an adequate follow-up based on the available resources. Nevertheless, many things may hamper the vision of precision medicine in TB, such as the complexity and the costs to develop novel compounds and the costs related to global-scale implementation of patient-centered follow-up. To achieve the ambitious goal of TB elimination, a radical change in TB treatment is needed in order to give a more comprehensive approach based both on patients' peculiarities and driven by drug susceptibility tests and whole-genome sequencing.
近几十年来，耐药结核病菌株的出现阻碍了国际社会在全球消除该疾病的努力。世界卫生组织（WHO）已经起草了许多战略来实现这一宏伟目标。最初，目标是规范许多国家使用的不充分治疗方案，此后，发展到解决阻碍结核病消除的社会决定因素。然而，在沿着缩小临床视野以应对结核病的道路前进之后，越来越需要根据患者和病原体的独特特征对治疗进行个性化。在我们的叙述性综述中，我们报告了在开发一种将精准医学概念应用于结核病治疗的方法方面的优势和不足。在本论文中，我们强调了应对包括宿主和病原体特征在内的疾病不同方面的重要性，以及根据现有资源进一步实施充分随访的必要性。然而，许多因素可能会阻碍结核病精准医学的发展，例如开发新化合物的复杂性和成本，以及与以患者为中心的随访在全球范围内实施相关的成本。为了实现消除结核病这一宏伟目标，需要对结核病治疗进行彻底变革，以便基于患者的特殊性并由药敏试验和全基因组测序推动，给出一种更全面的方法。
