Classifying new anti-tuberculosis drugs: rationale and future perspectives.
The classification of anti-tuberculosis (TB) drugs is important as it helps the clinician to build an appropriate anti-TB regimen for multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB cases that do not fulfil the criteria for the shorter MDR-TB regimen. The World Health Organization (WHO) has recently approved a revision of the classification of new anti-TB drugs based on current evidence on each drug. In the previous WHO guidelines, the choice of drugs was based on efficacy and toxicity in a step-down manner, from group 1 first-line drugs and groups 2-5 second-line drugs, to group 5 drugs with potentially limited efficacy or limited clinical evidence. In the revised WHO classification, exclusively aimed at managing drug-resistant cases, medicines are again listed in hierarchical order from group A to group D. In parallel, a possible future classification is independently proposed. The aim of this viewpoint article is to describe the evolution in WHO TB classification (taking into account an independently proposed new classification) and recent changes in WHO guidance, while commenting on the differences between them. The latest evidence on the ex-group 5 drugs is also discussed.
Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK.
Simon
S
Tiberi
The Global Fund to Fight Aids, Tuberculosis and Malaria, Geneva, Switzerland.
Anna
A
Scardigli
Fondazione S. Maugeri, IRCCS, Care and Research Institute, Via Roncaccio 16, 21049, Tradate, Italy.
Rosella
R
Centis
Fondazione S. Maugeri, IRCCS, Care and Research Institute, Via Roncaccio 16, 21049, Tradate, Italy; Public Health Consulting Group, Lugano, Switzerland.
Lia
L
D'Ambrosio
Tuberculosis Clinic, National Institute of Respiratory Diseases of Mexico (INER), Mexico City, Mexico.
Marcela
M
Muñoz-Torrico
Tuberculosis Clinic, National Institute of Respiratory Diseases of Mexico (INER), Mexico City, Mexico.
Miguel Ángel
MÁ
Salazar-Lezama
Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy; Pneumology Unit, Fondazione Maugeri, IRCCS, Care and Research Institute, Tradate, Italy.
Antonio
A
Spanevello
Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy.
Dina
D
Visca
Division of Infection and Immunity, University College London and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK.
Alimuddin
A
Zumla
Fondazione S. Maugeri, IRCCS, Care and Research Institute, Via Roncaccio 16, 21049, Tradate, Italy. Electronic address: giovannibattista.migliori@fsm.it.
Giovanni Battista
GB
Migliori
Pneumology Department, University Hospital of Gran Canaria "Dr Negrin", Las Palmas de Gran Canaria, Las Palmas, Spain; International Union against Tuberculosis and Lung Disease, Paris, France.
Jose A
JA
Caminero Luna
D000995:Antitubercular Agents / Q000145:classification* / Q000627:therapeutic use; D005075:Biological Evolution; D016903:Drug Monitoring; D006801:Humans; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*; D014944:World Health Organization
D000995:Antitubercular Agents
Anti-TB drugs; Bedaquiline; Delamanid ;; Fluoroquinolones; Linezolid; MDR/XDR-TB