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EX-DR TB: Elimination of Extensive Drug Resistance Through better Regimens for TB

Project description

Combatting extensively drug-resistant tuberculosis

In response to the global threat of multi-drug resistant and extensively drug-resistant tuberculosis (TB), the World Health Organization advised bedaquiline (BDQ)-based all-oral regimens in 2022. Recent reports, however, indicate that BDQ resistance is on the rise, necessitating alternative treatment strategies until new drugs can be made available. To address this, the EU-funded EX-DR TB project aims to develop tools that will help contain the emerging epidemic of BDQ-resistant TB. First, it will establish treatment recommendations based on targeted next-generation sequencing to inhibit the spread of BDQ-resistant bacteria. More importantly, it will perform a phase 3 clinical trial to thoroughly assess two treatment regimens of new drugs, aiming to advance one of them towards regulatory approval.

Objective

In 2022, the World Health Organization (WHO) recommended bedaquiline (BDQ)-based, all-oral regimens including pretomanid (Pa), linezolid (L), and moxifloxacin (M) (BPaLM), lasting 6-9 months
However, BDQ-resistance is rising dramatically and threatening these advancements. Mozambique has reported BDQ resistance in 28% of MDR-TB isolates in 2024, up from 3% in 2016 and at 10% in South Africa (Ndjeka N, personal communication).
Spread of BDQ-R TB must be slowed by antibiotic stewardship through more rapid, accurate, and near-patient diagnostics, and optimized management; until new treatment options with drugs that have no pre-existing resistance or are able to overcome small shifts in MIC will be available. The proposed EX-DR TB project includes diagnostic capacity strengthening, adapting treatment recommendations, and a trial of two new regimens composed of new drugs.
The EDCTP EX-DR TB project will:
1. Develop treatment recommendations by a Delphi process with stakeholders - to make use of targeted next generation sequencing (tNGS) that is being rolled out by most national TB programmes - this will yield short-term benefit for patients and NTPs; and will slow the spread of BDQ-resistant bacteria;
2. Rigorously evaluate two treatment regimens composed of new drugs, in a phase 3 clinical trial conducted to the highest regulatory standard – this will be the main focus of EX-DR TB. The trial objective will be to move a regimen towards regulatory approval by FDA and/or EMA, and WHO if supported by results.
Thus, EX-DR will create the tools for containing the nascent epidemic of BDQ-R TB and make them available to healthcare providers and TB Programmes. EX-DR TB will be embedded in a larger coalition of funders and partners focused on implementing and evaluating diagnostics and performing the trial beyond of the EDCTP funded area.

Fields of science (EuroSciVoc)

Keywords

Programme(s)

Topic(s)

Funding Scheme

HORIZON-JU-RIA - HORIZON JU Research and Innovation Actions

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Call for proposal

(opens in new window) HORIZON-JU-GH-EDCTP3-2024-01-two-stage

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Coordinator

LUDWIG-MAXIMILIANS-UNIVERSITAET MUENCHEN
Net EU contribution
€ 0,00
Address
GESCHWISTER SCHOLL PLATZ 1
80539 Planegg
Germany
Region
Bayern Oberbayern München, Kreisfreie Stadt
Activity type
Higher or Secondary Education Establishments
Links
Total cost
No data

Participants (13)

Partners (3)