From child-friendly medicines to shorter regimens for adults, several studies were presented at the recently-concluded Union Lung Health conference in Paris, to address multi-drug resistant tuberculosis (MDR-TB).

Four key studies addressing MDR-TB prevention and treatment for children were presented by the Unitaid-funded BENEFIT Kids project to address gaps, including how to best dose TB medicines for children — a key access barrier. The studies led by the Desmond Tutu TB Centre, Stellenbosch University (South Africa), bolster efforts “to produce more child-friendly, better-tasting medicines and formulations, to improve uptake, acceptability, and outcomes among children,” a note on the studies said. And, “it was motivated by the fact that the treatment of MDR-TB in children still lags dramatically behind recent advances in adult MDR-TB treatment”, it added.

Child-friendly treatment

The teams at Stellenbosch University along with the University of California (San Francisco) pooled data from five previously published studies with more than 240 children receiving levofloxacin. “This innovative approach has identified optimal doses of levofloxacin that can inform paediatric treatment guidelines,” the note said.

The studies complement the project’s PERFORM trial, in which researchers compared a new paediatric dispersible tablet formulation of levofloxacin to the current crushed levofloxacin adult tablets, examining the acceptability of the two medicines forms were among children.

Results were also presented from CATALYST, ChilPref and TB-CHAMP studies to provide new evidence to reduce the toll of MDR-TB in children.

The CATALYST trial studied the tolerability, among other features, of new child-friendly formulations of clofazimine and moxifloxacin.

This international multi-country study was conducted in India with partners from BJ Medical College and Johns Hopkins University, the Philippines with De La Salle Medical and Health Sciences Institute, and South Africa., the note said.

In the ChilPref study, researchers from Stellenbosch University and the TB Alliance evaluated the taste of formulations moxifloxacin and linezolid preferred by children. This research asked children to give their input on how medicines should taste. The currently available formulation of moxifloxacin, for example, was rejected by most children, it added.

MDR-TB does not respond to isoniazid and rifampicin, used in the “first-line” of treatment. About 30,000 children develop MDR-TB, annually, and yet, fewer than 20 per cent are diagnosed and treated, resulting in morbidity and mortality. More than 1,83,000 children die annually from the disease, and over 95 per cent of them are less than five years and did not receive treatment, the note said.

Three new regimens

Earlier at the conference, four new improved regimens to treat MDR and rifampicin-resistant (RR) TB were presented by the endTB consortium. The team was led by Médecins Sans Frontières (MSF), Partners In Health (PIH), and Interactive Research and Development (IRD) and funded by Unitaid.

The trial found three new drug regimens that can deliver similar efficacy and safety to conventional treatments while reducing treatment time by up to two-thirds, MSF said.

The endTB trial enrolled 754 patients from seven countries (Georgia, India, Kazakhstan, Lesotho, Pakistan, Peru, and South Africa). It included historically excluded populations like adolescents and those with comorbidities like substance-use disorders, and retained participants who became pregnant during the trial, the note said. “Roughly half a million people fall sick with MDR/RR-TB each year, and many die from it,” MSF added.

The trial evaluated five experimental regimens for MDR/RR-TB against the standard of care in two distinct analysis populations. The studies unveiled evidence for multiple innovative all-oral, shortened regimens that will allow patient-centered, individualized treatment of MDR-TB. said Lorenzo Guglielmetti, MSF Director for the endTB project and Co-Principal Investigator of the study.