New hope for patients with drug resistant TB

Francis Okoye, CNS Correspondent, Nigeria
Patients suffering from multi drug resistant TB (MDR-TB), now have the hope of a higher cure success rate with a more patient friendly treatment that was recently approved by World Health Organization (WHO). The new WHO recommendations aim to speed up detection and improve treatment outcomes for MDR-TB, through use of novel rapid diagnostic tests, and shorter and cheaper treatment regimens.

At $1000 per patient, the new treatment is less expensive than the current regimen, and also much shorter— it takes 9-12 months to complete against the current 24 month long treatment.

This is obviously expected to improve treatment adherence and reduce loss to follow up, thus potentially increasing survival rate. It will also help countries deliver on their promise to end TB by 2030, or earlier, as envisaged in the sustainable development goal 3.3. In a webinar organized by Citizen News  Services (CNS), for health writers around the world, experts including Dr I D Rusen, Senior Vice President,Research and Development at International Union  Against Tuberculosis and Lung Disease (The Union), Dr Fuad Mirzayev, Medical Officer at WHO Global TB Programme, Dr Sunil Khaparde,Deputy Director General Central TB Division, Ministry of Health and Family Welfare, Government of India, and Shobha Shukla, Managing Editor at CNS and moderator of the webinar, discussed the latest shorter, cheaper and possibly better MDR-TB treatment regimen. As per WHO’s Global TB Report 2015, the world recorded 480,000 new MDR-TB cases in 2014, out of which only ¼ were detected and treated, and only 50% of those put on treatment were cured. One reason for the low cure rate is that the current treatment of MDR-TB is lengthy and often difficult to tolerate.

The Bangladesh regimen

Dr Rusen, who leads the Treat TB Initiative and coordinated the STREAM clinical studies for shortened MDR-TB treatment regimen, informed that this regimen involves daily dose of Kanamycin, isoniazid, Prothionamide in the intensive phase (1st 4 months) and clofazimine, gatifloxacin, ethambutol and pyrazinamide for all 9 months. kanamycin is given 3 times/week in month 4 and the intensive  4 month phase can be extended by 3 months. Dr Rusen shared encouraging data from Bangladesh and other countries where these studies have taken place. Data for 515 patients in Bangladesh on the 9 month regimen shows a cure rate of 82.1%. In another cohort study of 1000 patients on a modified Bangladesh regimen in West Africa, interim analysis of 408 patients has demonstrated similar treatment success rate. Other randomised controlled studies of non inferiority design in stage1 and stage 2 have also kicked off, with fully oral 9 month regime and 6 month simplified regime. There are numerous other clinical research studies also planned/underway.

WHO treatment guidelines for MDR-TB 2016 update

Dr Fuad Mirzayev, who spoke on WHO Treatment guidelines for MDR-TB 2016 update, said that a shorter regimen is recommended with clofazimine/linezolid as core second line medicines and PAS as an add on. The new MDR-TB treatment is recommended for patients with rifampicin resistant (RR) TB, regardless of isoniazid resistance. It can be used for children, adults and people living with HIV suffering form pulmonary MDR-TB, but is not recommended for patients with extra pulmonary TB and/or pregnant women. While replying to questions from webinar participants, Dr Rusen informed that in the West Africa clinical STREAM study, of the 91 MDR-TB patients that received treatment, 74% were HIV positive. MDR-TB is a specific form of TB which is resistant to at least isoniazid and rifampicin, the two most powerful anti-TB drugs.

Drug resistance continues to emerge and spread due to mismanagement of drug sensitive TB and from person to person transmission. It is possible to treat MDR-TB but only with very expensive and potentially toxic treatment lasting up to 2 years. However, hope on the new, shorter and successful treatment for MDR-TB is now with us. It now depends upon the decision makers/governments of high TB burden countries to make use of this new found opportunity by adopting the WHO recommended new MDR-TB treatment guidelines. Only time will tell whether they can show the political will and acumen to do so.

Francis Okoye, Citizen News Service - CNS
June 28, 2016

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