德拉马尼治疗MDR/XDR-TB的研究进展

Research progress of Delamani in treatment of multidrug-resistant/extensively drug-resistant tuberculosis

目前,耐多药结核病(Multidrug-resistant tuberculosis,MDR-TB)和广泛耐药结核病(Extensively drug-resistant tuberculosis,XDR-TB)治疗耗时长、方案复杂、药物毒性大、疗效差。MDR-TB治疗成功率低(52%)、病死率高(17%)、失访率高(15%),而XDR-TB治疗成功率仅26%,迫切需要开发新药和构建新化疗方案以提高疗效。德拉马尼(Delamanid,Dlm)在体内、外对处于复制、休眠期的结核分枝杆菌(Mycobacterium tuberculosis,MTB)均具有较强的杀灭作用。含Dlm的最佳背景方案(Optimised background regimen,OBR)治疗MDR-TB患者可增加2个月末的痰培养转阴率,并显著改善患者预后和降低病死率。本文主要对Dlm的药物特点、体外活性、动物实验、疗效和安全性的研究进展作一综述。

The treatment of multidrug-resistant tuberculosis(MDR-TB)and extensively drug-resistant tuberculosis(XDR-TB)is prone to more time-consuming,complex,toxic and ineffective.MDR-TB has low treatment success rate(52%)and high fatality rate(17%),as well as high rate of lost visits(15%),while the treatment success rate of XDR-TB is only 26%.It’s urgent to develop new drugs and chemotherapy regimens to improve the efficacy for MDR/XDR-TB.Delamanid(Dlm)has a strong killing effect on Mycobacterium tuberculosis(MTB)in vitro and in vivo.When MDR-TB patients are treated with optimized background regimen containing Dlm,the two-month sputum negative conversion rate is increased,case fatality is decreased and the prognosis is improved.This article reviews the progress on characteristics,in vitro activity,animal tests,clinical efficacy and safety of Dlm.