Can the Addition of Verapamil to Bedaquiline-Containing Regimens Improve Tuberculosis Treatment Outcomes? A Novel Approach to Optimizing TB Treatment

adjunctive therapy • bedaquiline • cardiotoxicity • drug-resistant tuberculosis • verapamilTuberculosis (TB) is the second leading cause of mortality due to a single infectious agent worldwide.Despite the availability of effective chemotherapy for more than 50 years, a combination of many factors, including poor adherence to the drug regimen, limited health system resources and immune system compromise from HIV co-infection, have contributed to the emergence and spread of highly transmissible, drug-resistant strains of Mycobacterium tuberculosis (M.tb).According to WHO, there were 9 million cases of TB in 2013, and approximately 480,000 cases of multidrug resistant TB (MDR-TB) (M.tb with resistance to isoniazid and rifampin), the latter associated with an estimated 210,000 deaths.Extensively drug-resistant (XDR) and totally drug resistant (TDR) TB have become a global health threat.Moreover, many existing second-line drugs are highly toxic and poorly efficacious.The need for new drugs and tools to deal with the alarming spread of drug-resistant TB, and to shorten the duration of treatment for drug-sensitive TB, is highly imperative.Against this backdrop, and with very few anti-TB drugs in the pipeline, repurposing existing approved drugs as adjuvants to shorten treatment duration