Research points to individualized treatments for curing TB

Tuberculosis (TB) kills more people each year than any other infectious disease. But the best available treatment requires taking antibiotics daily for six months, a daunting regimen for patients living in developing countries.

Recent findings from the UCSF School of Pharmacy show that millions of lives might be saved by adjusting the duration of treatment for each patient, according to the severity of each patient’s disease.

The work, led jointly by Marjorie Imperial, a student in UCSF’s Pharmaceutical Sciences and Pharmacogenomics PhD degree program, and Payam Nahid, MD, MPH, a faculty member in the UCSF School of Medicine and physician in the Division of Pulmonary and Critical Care Medicine at the Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center, was published in Nature Medicine on November 5, 2018.

In the study, the researchers reexamined data from three clinical trials that had concluded that shortened TB regimens of four months were not as effective as the standard six-month regimens at treating the disease. By simultaneously analyzing data from all three trials, the UCSF team found that while the four-month regimen, indeed, wasn’t very effective at treating moderate or severe TB cases, it was very effective for patients who had minimal cases. The results also showed that for patients with severe cases of TB, six months of treatment wasn’t enough for a cure, implying that these patients might benefit from longer regimens.

The findings suggest that tailoring medication regimens for each patient could improve outcomes for the ten million new cases of TB that occur annually. The researchers also found that patients who skipped taking their medicine had a higher risk of treatment failure, bucking conventional wisdom in the field.

“People thought it was OK to miss some doses,” Rada Savic, PhD, a faculty member in the Department of Bioengineering and Therapeutic Sciences in the UCSF Schools of Pharmacy and Medicine, and the senior author of the study, told UCSF News Center. “But it’s not OK to miss even one out of 10 doses.”

Doctors worldwide are already accustomed to measuring TB severity in every patient, and the researchers believe that these new, case-by-case regimens could be easily applied in existing health care settings, sparing millions of lives.

More

• Pulmonary TB Can Be Cured with Shorter Treatment, Study Finds (UCSF News Center)
• Data for a Difference