Enthusiasm for the new anti-tuberculosis drugs bedaquiline and delaminid is tempered by concerns about their potential to cause cardiotoxicity. The drugs are associated with QT prolongation—an abnormal pattern on the electrocardiogram that can lead to a fatal arrhythmia. Older agents like fluoroquinolones, clofazimine and thioridazine have also been noted to cause this abnormality. It is unclear, however, whether QT prolongation is a perfect proxy measure for the risk of sudden cardiac death due to arrhythmia and which patients with this abnormality are at the highest risk for an adverse outcome.
Bedaquiline and delamanid are likely to form the backbone of treatment for drug-resistant TB in some combination with other potentially cardiotoxic drugs despite these risks because the need for effective therapy is so great. As we develop and modify treatment regimens using combinations of these new and old drugs, we will need to accurately account for and manage the risk of drug-induced cardiotoxicity. This Expert Panel will explore the risk of QT prolongation in emerging drug-resistant tuberculosis (DR-TB) therapy.
We’re pleased to welcome the following panelists for this discussion:
• Dr. Mathilde Jachym – Pulmonologist, Centre Hospitalier de Bligny, France
• Dr. Gene Kwan – Cardiologist, Boston University Medical Center, USA; Health and Policy Advisor for Non-communicable Diseases, Partners In Health, USA
• Dr. Michael Rich – Global Health Physician, Brigham and Women’s Hospital, Partners In Health, USA
• Dr. Peter Zimetbaum – Associate Chief and Director of Clinical Cardiology, Beth Israel Deaconess Medical School, USA
During our week-long discussion, panelist will address the following questions:
• What is the risk of fatal cardiac arrhythmias in DR-TB treatment?
• What are the advantages and disadvantages of using QTc prolongation as the approximation of risk for arrhythmia in patients on DR-TB treatment?
• What are the obstacles to implementation of electrocardiogram monitoring and how can they be overcome?
• What is the best strategy for managing arrhythmia risk in patients on DR-TB treatment?
• How should cardiotoxic anti-TB drugs be combined into treatment regimens?
We encourage you to join the conversation and share your comments and questions with the community.