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- To end TB, we need to rethink how trials are done: - Support leadership from high-burden countries - Cut costs and bureaucracy - Integrate trials into national TB systems - Build local capacity, not dependency on CROs It’s not just more efficient, it’s more just. #ESCMID2025
- TB meningitis reminds us: it’s not just about killing bugs. Outcomes are shaped by both bacterial killing and inflammation. Guy Thwaites made the case for host-directed therapies, and even personalized approaches, as essential tools in ending TB. #ESCMID2025 #TBM
- In HIV-associated TB meningitis, CSF inflammation is high, but dexamethasone didn’t improve survival. Guy Thwaites discussed results from the Donovan et al RCT: nejm.org/doi/full/10.1056/NEJMoa2216218 ~50% had CD4 ≤50. Despite immune activation, no mortality benefit was seen. #ESCMID2025 #TBM
- In HIV-negative TB meningitis, dexamethasone improves survival, but not for everyone. Guy Thwaites highlighted genotype-stratified data (LTA4H): - TT genotype: strong survival benefit - CC genotype: no benefit Personalized adjunctive therapy may be the future. #ESCMID2025 #TBM
- Guy Thwaites challenged the old Everest expedition model of TB trials- slow, expensive, high-income-led. He proposed a better way: agile, local, cost-effective. Like Nimsdai Purja’s rapid ascent of all 14 8000m peaks, the future of TB trials must be faster, smarter, locally led. #ESCMIDGlobal2025Apr 13, 2025 16:19
