The STREAM trial: missed opportunities and lessons for future clinical trials.
Journal
Lancet Infectious DiseasesAbstract
Final results of the STREAM trial were presented at the 2018, 49th Union World Conference on Lung Health, held in The Hague, The Netherlands. STREAM is a randomised controlled trial comparing the 18–24 month WHO-recommended multidrug-resistant tuberculosis (MDR-TB) treatment regimen with a 9–12 month regimen similar to that first described in Bangladesh. 1 Under programmatic conditions, the longer regimen results in treatment success for approximately 50% of patients, 2 whereas the shorter 9–12 month regimen improved treatment success to 80% or higher in selected countries. 3 , 4 Because these countries had relatively low HIV prevalence and relatively high percentages of treatment success with the longer regimens, questions around generalisability were raised. 4 STREAM was a multi-million dollar undertaking that took almost 10 years from the time of study design until the release of final results. Given the time and costs involved it is essential to reflect on lessons learned, and what the trial results tell us to inform how we accumulate future evidence to guide MDR-TB treatment.Publisher
ElsevierPubMed ID
30910428Language
enISSN
1474-4457ae974a485f413a2113503eed53cd6c53
10.1016/S1473-3099(19)30106-9
Scopus Count
Collections
Related articles
- Combined treatment of drug-resistant tuberculosis with bedaquiline and delamanid: a systematic review.
- Authors: Pontali E, Sotgiu G, Tiberi S, Tadolini M, Visca D, D'Ambrosio L, Centis R, Spanevello A, Migliori GB
- Issue date: 2018 Jul
- Bedaquiline and delamanid in combination for treatment of drug-resistant tuberculosis.
- Authors: Mohr E, Ferlazzo G, Hewison C, De Azevedo V, Isaakidis P
- Issue date: 2019 May
- [New antitubercular agents are not where where we need them to be].
- Authors: Nau JY
- Issue date: 2015 Dec 16
- Bedaquiline or delamanid for rifampin-resistant tuberculosis?
- Authors: Lessem E, Cox V, Furin J
- Issue date: 2017 Oct
- India plans to expand access to new tuberculosis drug.
- Authors: Sharma DC
- Issue date: 2017 Feb 18