Sterilizing activities of novel combinations lacking first- and second-line drugs in a murine model of tuberculosis

Antimicrob Agents Chemother. 2012 Jun;56(6):3114-20. doi: 10.1128/AAC.00384-12. Epub 2012 Apr 2.

Abstract

Novel oral regimens composed of new drugs with potent activity against Mycobacterium tuberculosis and no cross-resistance with existing agents are needed to shorten and simplify treatment for both drug-susceptible and drug-resistant tuberculosis. As part of a continuing effort to evaluate novel drug combinations for treatment-shortening potential in a murine model, we performed two long-term, relapse-based experiments. In the first experiment, several 3- and 4-drug combinations containing new agents currently in phase 2/3 trials (TMC207 [bedaquiline], PA-824 and PNU-100480 [sutezolid], and/or clofazimine) proved superior to the first-line regimen of rifampin, pyrazinamide, and isoniazid. TMC207 plus PNU-100480 was the most effective drug pair. In the second experiment, in which 3- and 4-drug combinations composed of TMC207 and pyrazinamide plus rifapentine, clofazimine, PNU-100480, or both rifapentine and clofazimine were evaluated, the rank order of drugs improving the sterilizing activity of TMC207 and pyrazinamide was as follows: rifapentine plus clofazimine ≥ clofazimine ≥ rifapentine > PNU-100480. The results revealed potential new building blocks for universally active short-course regimens for drug-resistant tuberculosis. The inclusion of pyrazinamide against susceptible isolates may shorten the duration of treatment further.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Animals
  • Antitubercular Agents / administration & dosage*
  • Antitubercular Agents / therapeutic use*
  • Drug Therapy, Combination
  • Female
  • Isoniazid / administration & dosage
  • Isoniazid / therapeutic use
  • Mice
  • Mice, Inbred BALB C
  • Mycobacterium tuberculosis / drug effects
  • Mycobacterium tuberculosis / pathogenicity
  • Nitroimidazoles / administration & dosage
  • Nitroimidazoles / therapeutic use
  • Oxazolidinones / administration & dosage
  • Oxazolidinones / therapeutic use
  • Pyrazinamide / administration & dosage
  • Pyrazinamide / therapeutic use
  • Rifampin / administration & dosage
  • Rifampin / analogs & derivatives
  • Rifampin / therapeutic use
  • Tuberculosis / drug therapy*
  • Tuberculosis, Multidrug-Resistant / drug therapy

Substances

  • Antitubercular Agents
  • Nitroimidazoles
  • Oxazolidinones
  • PNU-100480
  • pretomanid
  • Pyrazinamide
  • Isoniazid
  • Rifampin
  • rifapentine