Over two billion people Worldwide are estimated to be carrying Latent TB.
Unless illness or age reduces the efficacy of the carrier's immune system there are no symptoms, and the carrier doesn't infect others.
But the WHO cannot succeed in its ultimate goal of eradicating TB from the face of the planet without treating all carriers of the disease - latent or active.
At present it's only feasible to treat Latent TB if the carrier lives in a country where active TB is already under control. In the US, for example, the standard treatment is nine months of isoniazid.
Isoniazid is also a first-line antibiotic for routine TB infection, and there are a host of side effects associated with its use.
Clearly there is now the potential to treat Latent TB with Arikace - perhaps in combination with isoniazid over a shorter period than nine months.
Looking further forward, Insmed may have been planning all along to develop an inhaled amikacin / isoniazid / rifampicin combination (or something along those lines) which would be a far safer and more patient-friendly therapy for Latent TB.
But a monster opportunity now beckons in the treatment of active TB infection.
I've suggested it would be illogical for the FDA and EMA not to approve Arikace for the treatment of any drug-resistant pulmonary infection currently treated with aminoglycoside injections.
But the main reason there is now such a problem with drug-resistant TB is that the regimen for routine TB infection has significant adverse effects.
Patients taking breaks because of persistent nausea and other problems allowed drug-resistant strains to evolve in the first place.
Who's to say the FDA and EMA won't go even further - and approve Arikace for the treatment of any amikacin-susceptible pulmonary infection?
That would allow the approved use of Arikace as a first-line antibiotic for TB - a target population in the millions instead of the paltry 630,000 with MDR-TB :-)