Editing Tuberculosis (section)

== Research ==
{{see also|International Congress on Tuberculosis}}
The BCG vaccine has limitations and research to develop new TB vaccines is ongoing.<ref name="Martín Montañés-2011">{{cite journal | vauthors = Martín Montañés C, Gicquel B | title = New tuberculosis vaccines | journal = Enfermedades Infecciosas y Microbiologia Clinica | volume = 29 | pages = 57–62 | date = March 2011 | issue = Suppl 1 | pmid = 21420568 | doi = 10.1016/S0213-005X(11)70019-2 }}</ref> A number of potential candidates are currently in [[clinical trial|phase I and II clinical trials]].<ref name="Martín Montañés-2011"/><ref>{{cite journal | vauthors = Zhu B, Dockrell HM, Ottenhoff TH, Evans TG, Zhang Y | title = Tuberculosis vaccines: Opportunities and challenges | journal = Respirology | volume = 23 | issue = 4 | pages = 359–368 | date = April 2018 | pmid = 29341430 | doi = 10.1111/resp.13245 | doi-access = free | hdl = 1887/77156 | hdl-access = free }}</ref> Two main approaches are used to attempt to improve the efficacy of available vaccines. One approach involves adding a subunit vaccine to BCG, while the other strategy is attempting to create new and better live vaccines.<ref name="Martín Montañés-2011"/> [[MVA85A]], an example of a subunit vaccine, is in trials in South Africa as of 2006, is based on a genetically modified [[vaccinia]] virus.<ref name=Ibanga_2006>{{cite journal | vauthors = Ibanga HB, Brookes RH, Hill PC, Owiafe PK, Fletcher HA, Lienhardt C, Hill AV, Adegbola RA, McShane H | title = Early clinical trials with a new tuberculosis vaccine, MVA85A, in tuberculosis-endemic countries: issues in study design | journal = The Lancet. Infectious Diseases | volume = 6 | issue = 8 | pages = 522–8 | date = August 2006 | pmid = 16870530 | doi = 10.1016/S1473-3099(06)70552-7 }}</ref> Vaccines are hoped to play a significant role in treatment of both latent and active disease.<ref>{{cite journal | vauthors = Kaufmann SH | title = Future vaccination strategies against tuberculosis: thinking outside the box | journal = Immunity | volume = 33 | issue = 4 | pages = 567–77 | date = October 2010 | pmid = 21029966 | doi = 10.1016/j.immuni.2010.09.015 | doi-access = free }}</ref>

To encourage further discovery, researchers and policymakers are promoting new economic models of vaccine development as of 2006, including prizes, tax incentives, and [[advance market commitments]].<ref>{{cite journal| vauthors = Webber D, Kremer M |url=https://www.who.int/bulletin/archives/79(8)735.pdf |title=Stimulating Industrial R&D for Neglected Infectious Diseases: Economic Perspectives|journal=Bulletin of the World Health Organization|volume=79|issue=8|year=2001|pages=693–801|url-status=live|archive-url=https://web.archive.org/web/20070926012031/http://www.who.int/bulletin/archives/79(8)735.pdf|archive-date=26 September 2007}}</ref><ref>{{cite journal| vauthors = Barder O, Kremer M, Williams H |s2cid=154454583|url=http://www.bepress.com/ev/vol3/iss3/art1|title=Advance Market Commitments: A Policy to Stimulate Investment in Vaccines for Neglected Diseases|journal=The Economists' Voice|volume=3|year=2006|issue=3|doi=10.2202/1553-3832.1144|archive-url=https://web.archive.org/web/20061105083659/http://www.bepress.com/ev/vol3/iss3/art1|archive-date=5 November 2006}}</ref> A number of groups, including the [[Stop TB Partnership]],<ref>{{cite book | author = Department of Economic and Social Affairs |title=Achieving the global public health agenda: dialogues at the Economic and Social Council|year=2009|publisher=[[United Nations]]|location=New York|isbn=978-92-1-104596-3|page=103|url=https://books.google.com/books?id=VeF9dv74C4MC&pg=PA103 |url-status=live|archive-url=https://web.archive.org/web/20150906212013/https://books.google.com/books?id=VeF9dv74C4MC&pg=PA103|archive-date=6 September 2015}}</ref> the South African Tuberculosis Vaccine Initiative, and the Aeras Global TB Vaccine Foundation, are involved with research.<ref>{{cite book| vauthors = Jong EC, Zuckerman JN |title=Travelers' vaccines|year=2010|publisher=People's Medical Publishing House|location=Shelton, CT|isbn=978-1-60795-045-5|page=319|url=https://books.google.com/books?id=BKRpWFEy66wC&pg=PA319|edition=2nd|url-status=live|archive-url=https://web.archive.org/web/20150906203627/https://books.google.com/books?id=BKRpWFEy66wC&pg=PA319|archive-date=6 September 2015}}</ref> Among these, the Aeras Global TB Vaccine Foundation received a gift of more than $280&nbsp;million (US) from the [[Bill and Melinda Gates Foundation]] to develop and license an improved vaccine against tuberculosis for use in high burden countries.<ref>{{Cite web|last=Bill and Melinda Gates Foundation Announcement |title=Gates Foundation Commits $82.9 Million to Develop New Tuberculosis Vaccines |date=12 February 2004 |url=http://www.globalhealth.org/news/article/4134 |archive-url=https://web.archive.org/web/20091010163118/http://www.globalhealth.org/news/article/4134 |archive-date=10 October 2009 }}</ref><ref>{{Cite web| vauthors = Nightingale K |title=Gates foundation gives US$280&nbsp;million to fight TB|date=19 September 2007|url=http://www.scidev.net/en/news/gates-foundation-gives-us280-million-to-fight-tb.html|url-status=live|archive-url=https://web.archive.org/web/20081201175618/http://www.scidev.net/en/news/gates-foundation-gives-us280-million-to-fight-tb.html|archive-date=1 December 2008}}</ref>

In 2012 a new medication regimen was approved in the US for multidrug-resistant tuberculosis, using [[bedaquiline]] as well as existing drugs. There were initial concerns about the safety of this drug,<ref name="Zumla2012">{{cite journal | vauthors = Zumla A, Hafner R, Lienhardt C, Hoelscher M, Nunn A | title = Advancing the development of tuberculosis therapy | journal = Nature Reviews. Drug Discovery | volume = 11 | issue = 3 | pages = 171–172 | date = March 2012 | pmid = 22378254 | doi = 10.1038/nrd3694 | url = http://www.nature.com/articles/nrd3694 | url-status = live | access-date = 8 May 2020 | s2cid = 7232434 | archive-url = https://web.archive.org/web/20200112192759/https://www.nature.com/articles/nrd3694 | archive-date = 12 January 2020 }}</ref><ref>{{cite news |date=31 December 2012 |title=J&J Sirturo Wins FDA Approval to Treat Drug-Resistant TB |url=https://www.bloomberg.com/news/2012-12-31/j-j-sirturo-wins-fda-approval-to-treat-drug-resistant-tb.html |url-status=live |archive-url=https://web.archive.org/web/20130104110903/http://www.bloomberg.com/news/2012-12-31/j-j-sirturo-wins-fda-approval-to-treat-drug-resistant-tb.html |archive-date=4 January 2013 |access-date=1 January 2013 |newspaper=[[Bloomberg News]]}}</ref><ref>{{cite journal | vauthors = Avorn J | title = Approval of a tuberculosis drug based on a paradoxical surrogate measure | journal = JAMA | volume = 309 | issue = 13 | pages = 1349–1350 | date = April 2013 | pmid = 23430122 | doi = 10.1001/jama.2013.623 }}</ref><ref>{{cite web |last=US Food and Drug Administration |title=Briefing Package: NDA 204–384: Sirturo |url=https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/Anti-%20InfectiveDrugsAdvisoryCommittee/UCM329258.pdf |url-status=live |archive-url=https://web.archive.org/web/20140104212835/https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/Anti-%20InfectiveDrugsAdvisoryCommittee/UCM329258.pdf |archive-date=4 January 2014 |website=[[Food and Drug Administration]]}}</ref><ref>{{cite journal |vauthors=Zuckerman D, Yttri J |date=January 2013 |title=Antibiotics: When science and wishful thinking collide |url=https://www.healthaffairs.org/do/10.1377/forefront.20130125.027503 |url-status=live |journal=Health Affairs |doi=10.1377/forefront.20130125.027503 |archive-url=https://web.archive.org/web/20220329211404/https://www.healthaffairs.org/do/10.1377/forefront.20130125.027503 |archive-date=29 March 2022 |access-date=29 March 2022}}</ref> but later research on larger groups found that this regimen improved health outcomes.<ref>{{cite journal | vauthors = Mbuagbaw L, Guglielmetti L, Hewison C, Bakare N, Bastard M, Caumes E, Fréchet-Jachym M, Robert J, Veziris N, Khachatryan N, Kotrikadze T, Hayrapetyan A, Avaliani Z, Schünemann HJ, Lienhardt C | title = Outcomes of Bedaquiline Treatment in Patients with Multidrug-Resistant Tuberculosis | journal = Emerging Infectious Diseases | volume = 25 | issue = 5 | pages = 936–943 | date = May 2019 | pmid = 31002070 | pmc = 6478224 | doi = 10.3201/eid2505.181823 }}</ref> By 2017 the drug was used in at least 89 countries.<ref name="Khoshnood-2021">{{cite journal | vauthors = Khoshnood S, Taki E, Sadeghifard N, Kaviar VH, Haddadi MH, Farshadzadeh Z, Kouhsari E, Goudarzi M, Heidary M | title = Mechanism of Action, Resistance, Synergism, and Clinical Implications of Delamanid Against Multidrug-Resistant ''Mycobacterium tuberculosis'' | journal = Frontiers in Microbiology | volume = 12 | page = 717045 | date = 2021-10-07 | pmid = 34690963 | pmc = 8529252 | doi = 10.3389/fmicb.2021.717045 | doi-access = free }}</ref> Another new drug is [[delamanid]], which was first approved by the European Medicines Agency in 2013 to be used in multidrug-resistant tuberculosis patients,<ref>{{Cite web |date=2013-12-03 |title=European Medicines Agency – News and Events – European Medicines Agency recommends two new treatment options for tuberculosis |url=http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2013/11/news_detail_001972.jsp&mid=WC0b01ac058004d5c1 |access-date=2024-04-09 |archive-url=https://web.archive.org/web/20131203022613/http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2013/11/news_detail_001972.jsp&mid=WC0b01ac058004d5c1 |archive-date=3 December 2013 }}</ref> and by 2017 was used in at least 54 countries.<ref name="Khoshnood-2021"/>

Steroids add-on therapy has not shown any benefits for active pulmonary tuberculosis infection.<ref>{{cite journal | vauthors = Critchley JA, Orton LC, Pearson F | title = Adjunctive steroid therapy for managing pulmonary tuberculosis | journal = The Cochrane Database of Systematic Reviews | issue = 11 | pages = CD011370 | date = November 2014 | volume = 2014 | pmid = 25387839 | pmc = 6532561 | doi = 10.1002/14651858.CD011370 }}</ref>