title: Emerging drugs and alternative possibilities in the treatment of tuberculosis.
abstract: BACKGROUND
  Tuberculosis (TB) remains a global health problem. Drug resistance, treatment duration, complexity, and adverse drug reactions associated with anti-TB regimens are associated with treatment failure, prolonged infectiousness and relapse. With the current set of anti-TB drugs the goal to end TB has not been met. New drugs and new treatment regimens are needed to eradicate TB.
  
  
  METHODS
  Literature was explored to select publications on drugs currently in phase II and phase III trials. These include new chemical entities, immunotherapy, established drugs in new treatment regimens and vaccines for the prophylaxis of TB.
  
  
  CONCLUSIONS
  Well designed trials, with detailed pharmacokinetic/pharmacodynamic analysis, in which information on drug exposure and drug susceptibility of the entire anti-TB regimen is included, in combination with long-term follow-up will provide relevant data to optimize TB treatment. The new multi arm multistage trial design could be used to test new combinations of compounds, immunotherapy and therapeutic vaccines. This new approach will both reduce the number of patients exposed to inferior treatment and the financial burden. Moreover, it will speed up drug evaluation. Considering the investments involved in development of new drugs it is worthwhile to thoroughly investigate existing, non-TB drugs in new regimens.
authors: a University of Groningen , University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology , Groningen , the Netherlands.
authors: S
authors: S
authors: Hofman
authors: a University of Groningen , University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology , Groningen , the Netherlands.
authors: M M
authors: MM
authors: Segers
authors: a University of Groningen , University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology , Groningen , the Netherlands.
authors: S
authors: S
authors: Ghimire
authors: a University of Groningen , University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology , Groningen , the Netherlands.
authors: M S
authors: MS
authors: Bolhuis
authors: a University of Groningen , University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology , Groningen , the Netherlands.
authors: M G G
authors: MG
authors: Sturkenboom
authors: b Departments of Pulmonary Diseases and Medical Microbiology , Nijmegen Medical Center, Radboud University , Nijmegen , The Netherlands.|c National Tuberculosis Reference Laboratory , National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands.
authors: D
authors: D
authors: Van Soolingen
authors: a University of Groningen , University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology , Groningen , the Netherlands.
authors: J W C
authors: JW
authors: Alffenaar
mesh_terms: D000818:Animals; D000995:Antitubercular Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D015195:Drug Design; D024881:Drug Resistance, Bacterial; D014943:Global Health; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents
keywords: Tuberculosis; immunotherapy; phase II/III; vaccines