A Shorter And Cheaper MDR-TB Treatment is just round the corner

Shobha Shukla - CNS
While the number of people detected with MDR-TB increased to 94,000 globally in 2012 (by more than 40%) this amounts to less than 20% of those actually estimated to have MDR-TB. Even amongst the lucky few who did get diagnosed, almost 17, 000 of them could not be put on treatment for a variety of reasons: lack of political commitment, inadequate financing, bottlenecks in uninterrupted drug supply, human resource shortage - to name a few. Failure to test and treat all those with MDR-TB not only has grave consequences for those affected but also poses serious public health risks.

Speaking at the 44th Union World Conference on Lung Health in Paris, Dr Mario Raviglione, Director, WHO Global Tuberculosis Programme, lamented that, “The gap between those diagnosed with MDR-TB and those put on treatment is increasing. Although more MDR-TB patients are being diagnosed now, thanks to new diagnostics like the Gene Xpert MTB/RIF, there are not enough drugs to put all of them on treatment. Diagnosing and not putting them on treatment is unethical. Treatment capacity should match with diagnostic capacity.”

As we all know, the current MDR-TB treatment regimen is 24 months long and the drugs are very toxic with debilitating side effects. In its fight against MDR-TB, the International Union Against Tuberculosis and Lung Disease (The Union) had launched an international trial of a 9-month standardised treatment regimen for MDR-TB in 2010. This regimen of seven drugs has proved to be effective in a cohort of patients treated in Bangladesh and few other countries.

Dr Arnaud Trebucq of the Department of TB and HIV, The Union, shared some positive developments of his ‘research on short-course treatment regimens for MDR-TB’ at the aforesaid press conference. Dr Trebucq said to Citizen News Service (CNS) that, “The current internationally approved 24 month regimen is much better than the situation 10 years ago having MDR-TB was like a death sentence with no treatment available for it. Yet it is not a patient friendly regimen and a significant number do not complete their treatment as it is of long duration and the drugs are very toxic and have side effects.”

Dr Trebucq presented some interesting data comparing the current WHO approved 24 months regimen for MDR-TB with the 9 month short course regimen which is yet to be approved by the WHO.


24 month regimen
study involving 9153 people with MDR-TB from different countries over the world
9 month regimen
study involving 709 people with MDR-TB from Bangladesh, Cameroon, Benin and Niger
CURE RATE
                     54%
                   88%
DEATH RATE
                     15%
                    5%
LOST TO FOLLOW UP
                     23%
                    6%
FAILURES
                       8%
                     1%


        Relapses--4











The new regimen not only reduces the treatment time by almost 66%, it also cuts down the treatment cost by 75%. It is being rolled out with the support of WHO and French Government in an observational study (with a strict follow up) in 9 more countries and will involve over 1000 people with MDR-TB in 2 years, recruitment for which has already begun.

Dr Trebucq was excited that, “The new regimen is a revolution indeed as it involves the use of existing drugs, is more patient friendly and can be managed relatively easily and gives a lot of hope to a lot many people in many countries. There will be lesser likelihood of developing XDR-TB with this shorter regimen than with the 24 month regimen. The aim is to cure more patients of MDR-TB and avoid developing of XDR-TB, by ensuring better treatment compliance. It is now for the governments to push for studies of this regimen in their countries in order to collect more evidence proving its efficacy. But this regimen is not for treatment of XDR-TB.”

Dr Trebucq was hopeful that once the results of the rigorous STREAM (Standardised Treatment Regimen of Anti-TB drugs for patients with Multiple drug-resistant TB) study being done in the 9 countries in South Africa were available in 2 or 3 years’ time, WHO would recommend this regimen.

Dr Raviglione, while conceding that the shorter regimen is not currently recommended by WHO, said that, “The review committee at WHO is extremely strict. As of now we find the results very promising and hope the study goes through. We need to have convincing evidence about the public health benefits, efficacy, and cost effectiveness of the new regimen. It is an evidence based process. So The Union will have to provide as much evidence as possible that it can be used in different settings. Presently countries who want to use this regimen through the Global Fund [to Fight AIDS, Tuberculosis and Malaria] are being permitted to do so provided they have an ethical committee to approve. “

So  while sufficient evidence is being collected on the long term suitability of this excitingly short duration treatment (which has already shown positive results) for the WHO to approve it, let us ensure that the gaping gap between those diagnosed and those actually put on MDR-TB treatment is plugged by making available the current WHO approved MDR-TB treatment regimens to all those in need of it.

Shobha Shukla, Citizen News Service - CNS
November 2013
(The author is supported by the Lilly MDR TB Partnership to provide conference coverage from the 44th Union World Conference on Lung Health in Paris, France: 30th October – 3rd November 2013. She is the Managing Editor of Citizen News Service - CNS, is a J2J Fellow of National Press Foundation (NPF) USA and received her editing training in Singapore. She has earlier worked with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also co-authored and edited publications on childhood TB, childhood pneumonia, Hepatitis C Virus and HIV, violence against women and girls, and MDR-TB. Email: shobha@citizen-news.org, website: www.citizen-news.org) 

Published in: 
Citizen News Service - CNS 
The Asian Tribune, Sri Lanka/Thailand 
Modern Ghana News, Ghana 
The African Herald Express, Africa 
Bihar and Jharkhand News Service - BJNS
Mangalorean News, Mangalore, India 
Media For Freedom, Nepal 
All Voices News, India
The Africa Press Review, Africa 

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