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Nachman S, Ahmed A, Amanullah F, Becerra MC, Botgros R, Brigden G, Browning R, Gardiner E, Hafner R, Hesseling A, How C, Jean-Philippe P, Lessem E, Makhene M, Mbelle N, Marais B, McIlleron H, McNeeley DF, Mendel C, Murray S, Navarro E, Anyalechi EG, Porcalla AR, Powell C, Powell M, Rigaud M, Rouzier V, Samson P, Schaaf HS, Shah S, Starke J, Swaminathan S, Wobudeya E, Worrell C. Towards early inclusion of children in tuberculosis drugs trials: a consensus statement. THE LANCET. INFECTIOUS DISEASES 2015; 15:711-20. [PMID: 25957923 PMCID: PMC4471052 DOI: 10.1016/s1473-3099(15)00007-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Children younger than 18 years account for a substantial proportion of patients with tuberculosis worldwide. Available treatments for paediatric drug-susceptible and drug-resistant tuberculosis, albeit generally effective, are hampered by high pill burden, long duration of treatment, coexistent toxic effects, and an overall scarcity of suitable child-friendly formulations. Several new drugs and regimens with promising activity against both drug-susceptible and drug-resistant strains have entered clinical development and are either in various phases of clinical investigation or have received marketing authorisation for adults; however, none have data on their use in children. This consensus statement, generated from an international panel of opinion leaders on childhood tuberculosis and incorporating reviews of published literature from January, 2004, to May, 2014, addressed four key questions: what drugs or regimens should be prioritised for clinical trials in children? Which populations of children are high priorities for study? When can phase 1 or 2 studies be initiated in children? What are the relevant elements of clinical trial design? The consensus panel found that children can be included in studies at the early phases of drug development and should be an integral part of the clinical development plan, rather than studied after regulatory approval in adults is obtained.
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Affiliation(s)
| | - Amina Ahmed
- Levine Children's Hospital at Carolinas Medical Center, Charlotte, NC, USA
| | | | | | | | - Grania Brigden
- Médecins Sans Frontières, Access Campaign, Geneva, Switzerland
| | - Renee Browning
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Division of AIDS, Bethesda, MD, USA
| | | | - Richard Hafner
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Division of AIDS, Bethesda, MD, USA
| | - Anneke Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Cleotilde How
- Department of Pharmacology and Toxicology, University of the Philippines, Manila, Philippines
| | - Patrick Jean-Philippe
- Henry M Jackson Foundation-Division of AIDS, Contractor to National Institutes of Health, National Institute of Allergy and Infectious Diseases, Department of Health and Human Services, Bethesda, MD, USA
| | | | - Mamodikoe Makhene
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Division of AIDS, Bethesda, MD, USA
| | - Nontombi Mbelle
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | - Ben Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity and the Sydney Emerging Infectious Diseases and Biosecurity Institute and The Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Helen McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, South Africa
| | | | | | | | - Eileen Navarro
- Division of Anti-Infective Products; Office of Antimicrobial Products, Office of New Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - E Gloria Anyalechi
- US Centers for Disease Control and Prevention, Division of Tuberculosis Elimination, International Research and Programs Branch, Atlanta, GA, USA
| | - Ariel R Porcalla
- Division of Anti-Infective Products; Office of Antimicrobial Products, Office of New Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Clydette Powell
- US Agency for International Development, Washington, DC, USA
| | | | - Mona Rigaud
- New York University School of Medicine, NY, USA
| | | | - Pearl Samson
- Statistical and Data Analysis Center, Center for Biostatistics in AIDS Research and Frontier Science, Harvard School of Public Health, Boston, MA, USA
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Seema Shah
- Department of Bioethics, NIH Clinical Center, Bethesda, MD, USA
| | - Jeff Starke
- Baylor College of Medicine, Houston, TX, USA
| | | | - Eric Wobudeya
- Makerere University Johns Hopkins Research Collaboration, and Mulago National Referral Hospital, Kampala, Uganda
| | - Carol Worrell
- Eunice Kennedy Schriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD, USA
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