Advantages and Challenges of Tailored Regimens for Drug-Resistant Tuberculosis: A StopTB Italia Look into the Future

• Main Authors: Riccardi N, Villa S, Alagna R, Giacomelli A, Saderi L, Cirillo DM, Besozzi G, Sotgiu G, Codecasa L
• Format: Article
• Language: English
• Published: Dove Medical Press 2020-08-01
• Series: Infection and Drug Resistance
• Subjects: tuberculosis; drug-resistance; treatment; tailored; stoptb.
• Online Access: https://www.dovepress.com/advantages-and-challenges-of-tailored-regimens-for-drug-resistant-tube-peer-reviewed-article-IDR

Niccolò Riccardi,1,2,* Simone Villa,1,3,* Riccardo Alagna,1,4 Andrea Giacomelli,1,5 Laura Saderi,1,6 Daniela Maria Cirillo,1,4 Giorgio Besozzi,1 Giovanni Sotgiu,1,6 Luigi Codecasa1,7 1StopTB Italia Onlus, Milan 20159, Italy; 2Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona 37024, Italy; 3Centre for Multidisciplinary Research in Health Science, University of Milan, Milan 20122, Italy; 4IRCCS San Raffaele Scientific Institute, Milan 20132, Italy; 5III Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan 20157, Italy; 6Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy; 7Regional TB Reference Centre, Istituto Villa Marelli, Niguarda Hospital, Milan 20159, Italy*These authors contributed equally to this workCorrespondence: Niccolò RiccardiDepartment of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni N.5, 37024, Negrar di Valpolicella, Verona, ItalyTel [phone]Email [e-mail]: The emerge of drug-resistant tuberculosis (TB) strain in recent decades is hampering the efforts of the international community to eliminate the disease worldwide. The World Health Organization (WHO) has drafted many strategies to achieve this ambitious goal. In the very beginning, the aim was to standardize inadequate regimens used in many countries and, thereafter, evolved to tackle the social determinants which hinder TB elimination. However, following the path of narrowing the clinical vision to deal with TB, there is an increased need to personalize the treatment considering both patients and pathogen unique characteristics. In our narrative review, we report the advantages and the backwards in developing a method to implement the concept of precision medicine to the treatment of TB. In this dissertation, we highlight the importance to address different aspects of the diseases encompassing the host and pathogen features, as well as the needs to further implement an adequate follow-up based on the available resources. Nevertheless, many things may hamper the vision of precision medicine in TB, such as the complexity and the costs to develop novel compounds and the costs related to global-scale implementation of patient-centered follow-up. To achieve the ambitious goal of TB elimination, a radical change in TB treatment is needed in order to give a more comprehensive approach based both on patients’ peculiarities and driven by drug susceptibility tests and whole-genome sequencing.Keywords: tuberculosis, drug-resistance, treatment, tailored, StopTB