Bedaquiline: what might the future hold?

Emily S Shaw; Neil G Stoker; Jessica L Potter; Helgard Claassen; Alasdair Leslie; Conor D Tweed; Chen-Yuan Chiang; Francesca Conradie; Hanif Esmail; Christoph Lange; Lancelot Pinto; Oxana Rucsineanu; Derek J Sloan; Grant Theron; Phumeza Tisile; Teck Chuan Voo; Robin M Warren; Limakatso Lebina; Marc Lipman

doi:10.1016/S2666-5247(24)00149-6

Bedaquiline: what might the future hold?

Lancet Microbe. 2024 Jul 26:100909. doi: 10.1016/S2666-5247(24)00149-6. Online ahead of print.

Authors

Emily S Shaw¹, Neil G Stoker², Jessica L Potter³, Helgard Claassen⁴, Alasdair Leslie⁵, Conor D Tweed⁶, Chen-Yuan Chiang⁷, Francesca Conradie⁸, Hanif Esmail⁹, Christoph Lange¹⁰, Lancelot Pinto¹¹, Oxana Rucsineanu¹², Derek J Sloan¹³, Grant Theron¹⁴, Phumeza Tisile¹⁵, Teck Chuan Voo¹⁶, Robin M Warren¹⁷, Limakatso Lebina⁴, Marc Lipman¹⁸

Affiliations

¹ Division of Acute Medical Services, University College London Hospitals NHS Foundation Trust, London, UK. Electronic address: [email protected].
² Centre for Clinical Microbiology, Royal Free Campus, University College London, London, UK.
³ Respiratory Medicine, Division of Medicine, University College London, London, UK; Department of Respiratory Medicine, North Middlesex University Hospital, London, UK.
⁴ Africa Health Research Institute, Durban, South Africa.
⁵ Department of Infection and Immunity, University College London, London, UK; Africa Health Research Institute, Durban, South Africa.
⁶ MRC Clinical Trials Unit, University College London, London, UK.
⁷ Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; International Union Against Tuberculosis and Lung Disease, Paris, France.
⁸ Clinical HIV Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁹ MRC Clinical Trials Unit, University College London, London, UK; Institute for Global Health, University College London, London, UK; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
¹⁰ Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany; German Center of Infection Research (DZIF), Borstel, Germany; Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
¹¹ PD Hinduja National Hospital and Medical Research Centre, Mumbai, India.
¹² Moldova National Association of Tuberculosis Patients (SMIT), Bălți, Republic of Moldova.
¹³ School of Medicine, University of St Andrews, St Andrews, UK.
¹⁴ Department of Science and Innovation-National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
¹⁵ NGO TB Proof, Cape Town, South Africa.
¹⁶ Office of Ethics in Healthcare, SingHealth, Singapore.
¹⁷ Department of Science and Innovation - National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Cape Town, South Africa; South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
¹⁸ Respiratory Medicine, Division of Medicine, University College London, London, UK; Royal Free London NHS Foundation Trust, London, UK.

PMID: 39074472
DOI: 10.1016/S2666-5247(24)00149-6

Abstract

Tuberculosis drug development has stagnated for decades, so the recent availability of bedaquiline is welcome. Bedaquiline-containing regimens, now the first-line therapy recommended by WHO, have transformed the treatment of drug-resistant tuberculosis, offering safer and more effective oral treatment options. However, key obstacles need to be overcome to ensure global access and prevent the rapid development of resistance against this promising class of drugs. In this Personal View, building on an international workshop held in 2023, we evaluate the current evidence and suggest possible ways forward, recognising the tension between increasing use and slowing the rise of resistance. We also discuss problems in accessing bedaquiline-containing regimens, the potential widening of their use beyond drug-resistant tuberculosis, and lessons for utilising new drugs as they are developed.

Publication types

Review