Matthew Burman

M/XDR-TB treatment perspective: How to avoid mountains of pills via digital technologies: Correspondence

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QT prolongation and cardiac toxicity of new tuberculosis drugs in Europe: a Tuberculosis Network European Trialsgroup (TBnet) study

There is concern that many second-line drugs used to treat multidrug-resistant tuberculosis (MDR-TB) may cause fatal arrhythmias linked to QT interval prolongation. The QT interval, measured on an electrocardiogram (ECG), represents the duration of the ventricular electrical systole. In order to have a more reproducible value across time and heart rates, the QT interval is adjusted according to heart rate (as QTc). Fluoroquinolones and, possibly, clofazimine can prolong the QTc interval [1, 2], as do bedaquiline (Bdq) and delamanid (Dlm) [3, 4]. A QTc interval >500 ms is considered a risk factor for ventricular arrhythmias such as torsades de pointes (TdP) [5]. Overall, 10–20% of patients with drug-induced TdP have a genetic predisposition and more than 70% have at least two other risk factors, like older age, female sex and electrolyte disturbances [6]. In smaller cohorts, no cases of fatal arrhythmia have been reported in association with new tuberculosis (TB) drugs and deaths in Bdq/Dlm registration trials were not linked to prolonged QTc nor arrhythmias [3, 4, 7]. The objective of the study was to evaluate the clinical impact of QTc prolongation and the number of cardiac events in patients receiving Bdq/Dlm treatment for MDR-TB in treatment centres of the Tuberculosis Network European Trialsgroup (TBnet), a clinical research collaboration of the European Respiratory Society, within the World Health Organization (WHO) Europe region. Few cardiac arrhythmias and no fatalities were observed in MDR-TB patients treated with bedaquiline and delamanid http://ow.ly/2tC030koXJa

National roll-out of latent tuberculosis testing and treatment for new migrants in England: a retrospective evaluation in a high-incidence area

Latent tuberculosis infection (LTBI) screening is an important intervention for tuberculosis (TB) elimination in low-incidence countries and is, therefore, a key component of Englands TB control strategy. This study describes outcomes from a LTBI screening programme in a high-incidence area to inform national LTBI screening in England and other low-incidence countries. We conducted a retrospective cohort study of LTBI screening among eligible migrants (from high-incidence countries and entered the UK within the last 5 years), who were identified at primary-care clinics in Newham, London between August 2014 and August 2015. Multivariable logistic regression was used to identify factors associated with LTBI testing uptake, interferon-γ release assay (IGRA) positivity and treatment uptake. 40% of individuals offered LTBI screening received an IGRA test. The majority of individuals tested were 16–35 years old, male and born in India, Bangladesh or Pakistan. Country of birth, smoking status and co-morbidities were associated with LTBI testing uptake. IGRA positivity was 32% among those tested and was significantly associated with country of birth, age, sex and co-morbidities. This study identifies factors associated with screening uptake, IGRA positivity and treatment uptake, and improves understanding of groups that should be supported to increase acceptability of LTBI testing and treatment in the community. The LTBI screening programme is effective in identifying a high number of LTBI cases, but it is patient and provider-dependent http://ow.ly/AKMu30g1rMB