世衛組織宣布里程碑式變化的耐藥結核病治療
2022 年 12 月 15 日/部門新聞/日內瓦/世界衛生組織
世衛組織剛剛發布了關於治療耐藥結核病（DR-TB）的更新綜合指引，其中主要改進了耐多藥或耐利福平結核病（MDR/RR-TB）患者的治療選擇。 該指引包括一項關於使用由貝達喹啉(bedaquiline)、pretomanid、利奈唑胺 (linezolid)和莫西沙星 (moxifloxacin) ［BPaLM］ 組成的新型全口服 6 個月治療方案的新建議，用於患有 MDR/RR-TB 或對 MDR/RR-TB 具有額外氟喹諾酮類(fluoroquinolones) 藥物耐藥性的患者（前超級抗藥結核，pre-XDR-TB）。新推薦的 BPaLM 方案提供了更好的結果，顯著縮短了治療時間，從而顯著改善了 MDR/RR-TB 患者的生活質量。
「在新獲得的數據的基礎上，我們現在有了更好、更短的耐藥結核病全口服治療方案。 這是一個歷史性的變化，將對耐藥結核病患者大有裨益，減輕衛生系統的負擔並挽救生命」，世衛組織全球結核病規劃主任 Tereza Kasaeva 博士說。「我們現在呼籲國家結核病規劃和合作夥伴採取緊急行動，迅速過渡到新的耐藥結核病治療方案」。
世衛組織結核病綜合指引，第 4單元：治療——耐藥結核病治療，2022 年更新版包括所有當前關於耐藥結核病治療的建議，並輔以旨在協助會員國實施世衛組織建議的操作手冊 、技術合作夥伴和其他參與耐藥結核病患者管理的人員。 世衛組織結核病操作手冊第 4 單元：治療——耐藥結核病治療，2022 年更新版提供了實用指引，說明如何按照實現國家和全球影響所需的規模去實施推薦的治療方案。
更新後的指引和配套操作手冊旨在供國家結核病規劃，或衛生部、政策制定者和公共和私營部門以及社區中從事結核病和傳染病工作的技術組織的同等機構使用。 這些文件旨在促進世衛組織政策在該領域的應用，從而提高結核病服務的整體品質。
世衛組織歡迎公共和私營部門採取新舉措降低 pretomanid 和可能的其他成分藥物的定價——這將降低新的 BPaLM/BPaL 治療方案的成本，並使其更容易獲得。
為促進耐藥結核病治療新方案的實施，世衛組織將建立一個定期線上討論平台，該平台將包括耐多藥/耐藥結核病高負擔國家、民間社會、技術合作夥伴和捐助界等伙伴。
WHO announces landmark changes in treatment of drug-resistant tuberculosis
15 December 2022 /Departmental news/Geneva/WHO
WHO has just released updated consolidated guidelines on the treatment of drug-resistant TB (DR-TB) featuring major improvements in treatment options for people with multidrug-resistant or rifampicin-resistant tuberculosis (MDR/RR-TB). The guidelines include a new recommendation on the use of a novel all-oral 6-month regimen composed of bedaquiline, pretomanid, linezolid and moxifloxacin (BPaLM) in people suffering from MDR/RR-TB or MDR/RR-TB with additional resistance to fluoroquinolones (pre-XDR-TB). The newly recommended BPaLM regimen offers better outcomes, remarkably shortens the duration of treatment, and thus significantly improves quality of life for people with MDR/RR-TB.
‘’Building on the newly available data, we now have a better and shorter all-oral treatment option for drug-resistant TB. This is a historic change that will be of great benefit to people suffering from drug-resistant TB, easing the burden on health systems and saving lives,” said Dr. Tereza Kasaeva, Director of WHO’s Global TB Programme. “We now call for urgent action by national TB programmes and partners in rapidly transitioning to the new drug-resistant TB treatment regimen.’’
The WHO Consolidated Guidelines on Tuberculosis, Module 4: Treatment – Drug-Resistant Tuberculosis Treatment, 2022 update includes all the current recommendations on treatment of DR-TB, and is complemented by an operational handbook designed to assist the implementation of WHO recommendations by Member States, technical partners and others who are involved in the management of patients with DR-TB. The WHO Operational Handbook on Tuberculosis, Module 4: Treatment – Drug-Resistant Tuberculosis Treatment, 2022 update provides practical guidance on how to put in place the recommended treatment options at the scale needed to achieve national and global impact.
The updated guidelines and supporting operational handbook are designed for use by national TB programmes, or their equivalents in Ministries of Health, policy makers and technical organizations working on TB and infectious diseases in public and private sectors and in the community. These documents aim to facilitate uptake of WHO policy in the field and thus improve the overall quality of TB services.
WHO welcomes new initiatives by the public and private sectors to reduce the pricing of pretomanid and potentially other component medicines – that will lower the cost of the new BPaLM/BPaL treatment regimen and make it more accessible.
To facilitate and promote implementation of the new regimen for the treatment of DR-TB WHO will set up a regular online discussion platform that will include high MDR/RR-TB burden countries, civil society, technical partners and donor community.