Long-acting injections have been successfully used in contraception and more recently in HIV prevention. Now, researchers are exploring whether similar long-acting injections could be used for the prevention and treatment of tuberculosis.
Injections given every three months have been used for years as one of a number of contraceptive options for women. More recently, an antiretroviral injection administered every two months has been shown to be highly effective in preventing HIV infection and was recently approved for this use in the United States. In South Africa, medicines regulator Sahpra is reviewing the product.
Dr Eric Nuermberger, of the Centre for TB Research at Johns Hopkins University, says these regimens are highly effective when taken to completion, but their long duration — especially in the case of isoniazid — causes many people to stop taking it before completing the treatment and this can reduce effectiveness.
“The size of the injection, which usually goes into a muscle of the arm or buttock, is a major determinant of how acceptable the injection is to the recipient. So, whether enough drug can be squeezed into an acceptable volume for injection can be an important bottleneck in long-acting injection development.”
“It would make it much easier to bundle TPT with other health services for at-risk populations, for example, through drug abuse treatment programmes, maternal-child health visits, refugee services, incarcerated individuals, etc. Even mass treatment campaigns could be considered in areas of high endemicity and transmission.”Nuermberger’s group has a mouse model of TB preventive therapy that has been predictive of the efficacy of the regimens used in humans, including 3HP and 1HP.
While the current focus is on injections, other types of long-acting formulations such as polymer implants — similar to those already used in contraception — may also be possible. Such implants for HIV prevention are already being researched., the former head of clinical pharmacology at the University of Cape Town, Prof Gary Maartens, says it is an exciting time for TB. However, for long-acting injectables, there is still a long way to go and a lot of hurdles to overcome.
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