Connors William, Nishi Cesilia, Sekirov Inna, Cook Victoria, Johnston James
Department of Medicine, University of British Columbia, Vancouver, BC.
Tuberculosis Services, BC Centre for Disease Control, Vancouver, BC.
Can Commun Dis Rep. 2023 Jan 5;49(1):15-20. doi: 10.14745/ccdr.v49i01a04.
Drug-resistant tuberculosis (TB) is a major global health challenge in part because there are fewer effective treatments and these treatments have been prolonged and more toxic. The evidence base for more effective, shorter, standardized treatments is evolving rapidly. Herein, we report the first case of pre-extensively drug-resistant pulmonary TB treated with a novel six-month all oral bedaquiline, pretomanid and linezolid (BPaL) regimen in Canada. Recent clinical trial data supporting BPaL therapy is presented in the context of current and evolving clinical guidelines. In this article, we highlight significant implementation challenges and make recommendations for what needs to be addressed to ensure safe programmatic use of BPaL in Canada. Key recommendations include the development of infrastructure for timely access to novel TB drug susceptibility testing, streamlining access to novel TB drugs, and cautious use of such drugs in collaboration with care teams with expertise in drug-resistant TB management.
耐多药结核病是一项重大的全球卫生挑战，部分原因在于有效的治疗方法较少，而且这些治疗疗程延长且毒性更大。关于更有效、更短疗程的标准化治疗的证据基础正在迅速发展。在此，我们报告加拿大首例采用新型为期六个月的全口服贝达喹啉、普瑞玛尼和利奈唑胺（BPaL）方案治疗的广泛耐药前肺结核病例。在当前及不断演变的临床指南背景下，展示了支持BPaL疗法的近期临床试验数据。在本文中，我们强调了重大的实施挑战，并就加拿大确保安全地将BPaL用于项目治疗需要解决的问题提出建议。关键建议包括建立基础设施以便及时进行新型结核病药敏试验，简化新型结核病药物的获取途径，以及与具备耐多药结核病管理专业知识的护理团队合作谨慎使用此类药物。
