After decades without new drugs for tuberculosis (TB), there are now more options.

Bedaquiline (BDQ) has changed the TB treatment landscape as the first of these new drugs to be licensed for drug-resistant TB. Recent high profile clinical trials which included BDQ have shown efficacy with few adverse events against MDR/XDR TB, and in shorter regimens for drug-sensitive TB. For the first time in many years, the future looks bright.

However, resistance to BDQ is already present and capacity to detect it is limited. There is tension between the need for the manufacturers to recoup the costs of development, the ability of those in need to be able to afford it, and the global community’s responsibility to ensure that it is effective for as long as possible for the most resistant cases.

How does a clinician balance the needs of one patient with those of the population? Should it be used for NTM infections for which there is limited evidence, but few or no alternative options? What (expensive and lengthy) clinical trials should we embark on for the best outcome? Considering the risks around resistance, what is the place of bedaquiline in TB preventive therapy?

On Friday, 30th June, Africa Health Research Institute (AHRI) and UCL co-hosted an online symposium, bringing together experts from different regions and backgrounds – including TB survivors, policymakers, and researchers – to address these questions.

Limakatso Lebina, AHRI faculty member and clinical trials unit lead, and Marc Lipman, director of UCL-TB, were the co-chairs of the symposium, titled ‘Bedaquiline and TB: what might the future hold?‘. Panellists and presenters included Oxana Rucsineanu (TB survivor, Society of Moldova against Tuberculosis), Phumeza Tisile (TB survivor, Advocacy Officer, TB Proof, South Africa), Grant Theron (Stellenbosh University, South Africa), Lancelot Pinto (P.D.Hinduja National Hospital and Medical Research Centre, Mumbai, India), Francesca Conradie (University of the Witwatersrand, South Africa), Teck Chuan Voo (National University, Singapore), Rob Warren (Stellenbosch University, South Africa), Chen-Yuan Chiang (Taipei Medical University, Taiwan), Derek Sloan (University of St Andrews, UK), and Christoph Lange (University of Lübeck, Germany).

Watch a recording of the symposium below.