Tuberculosis (TB) drug discovery and development has undergone nothing short of a revolution over the past 20 years. Successful public–private partnerships and sustained funding have delivered a much-improved understanding of mycobacterial disease biology and pharmacology and a healthy pipeline that can tolerate inevitable attrition. Preclinical and clinical development has evolved from decade-old concepts to adaptive designs that permit rapid evaluation of regimens that might greatly shorten treatment duration over the next decade. But the past 20 years also saw the rise of a fatal and difficult-to-cure lung disease caused by nontuberculous mycobacteria (NTM), for which the drug development pipeline is nearly empty. Here, we discuss the similarities and differences between TB and NTM lung diseases, compare the preclinical and clinical advances, and identify major knowledge gaps and areas of cross-fertilization. We argue that applying paradigms and networks that have proved successful for TB, from basic research to clinical trials, will help to populate the pipeline and accelerate curative regimen development for NTM disease.

过去 20 年来，结核病 (TB) 药物的发现和开发经历了一场革命。成功的公私合作伙伴关系和持续的资助大大提高了对分枝杆菌疾病生物学和药理学的理解，并建立了能够承受不可避免的损耗的健康管道。临床前和临床开发已经从十年前的概念发展到适应性设计，可以快速评估可能在未来十年大大缩短治疗持续时间的治疗方案。但过去 20 年，由非结核分枝杆菌 (NTM) 引起的致命且难以治愈的肺部疾病也有所增加，而此类疾病的药物开发渠道几乎为零。在这里，我们讨论 TB 和 NTM 肺病之间的异同，比较临床前和临床进展，并确定主要知识差距和交叉领域。我们认为，从基础研究到临床试验，应用已被证明在结核病治疗中取得成功的范例和网络，将有助于充实管道并加速 NTM 疾病治疗方案的开发。