Is it the dawn of a new era for MDR-TB treatment?

Alice Tembe, CNS Correspondent, Swaziland
It has always been one too many people dying due to Multiple Drug Resistant TB (MDR-TB), a disease that can be cured. Even as the world of TB science has been evolving  since the past few decades, the degeneration of ordinary TB into drug resistant strains- that are more difficult to treat- continues unabated. Today, inroads are being made towards a new era of shorter, cheaper and better treatment drugs for MDR-TB.

A young physician who is a third generation medical practitioner in his family, Dr Solomon Dlamini (name changed) noted that, “A TB patient walking into a hospital today requires much more care, advanced equipment, tight infection control measures and stronger medication than 20 years ago, yet the list of diagnostic equipment and medication, as well as training of medical practitioners, has taken a snail’s pace towards any improvement.” The sentiments echoed by him are similar to those of The International Union against Tuberculosis and Lung Disease (The Union) that, it is time for shorter, cheaper and possibly less toxic MDR-TB treatment. This, Dlamini explained, will not just improve treatment adherence, treatment completion and treatment success rate in MDR-TB patients but also improve their quality of life. He felt that if other patients start witnessing the easier and more patient friendly treatment process, more will be inclined to test and enrol for treatment. 

Following the new WHO recommendations, aimed to speed up detection and improve treatment outcomes for MDR-TB through use of a novel rapid diagnostic test and a shorter, cheaper treatment regimen, Dr Mario Raviglione, Director of WHO’s Global TB Programme said that, “This is a critical step forward in tackling the MDR-TB public health crisis. The new WHO recommendations offer hope to hundreds of thousands of MDR-TB patients who can now benefit from a test that quickly identifies eligibility for the shorter regimen, and then complete treatment in half the time (12 months as opposed to the current 24 months) and at nearly half the cost (at $1000).” Themba Dlamini (name changed), a survivor of MDR-TB, explained that taking the medication meant saving his life, but the cost was just as much hard. Themba explained that, ‘In exchange for my life, I lost my job as a teacher due to the loss of my hearing and diminished eye sight. I can no longer drive anymore”. He believes that shorter, and less toxic regimens, involving fewer pills, will make a huge difference in patients completing their treatment successfully. In his case, a persistent treatment supporter and the support of his family kept him egging on to complete his treatment.

It is important to ensure the following during this game-changing development:
  • Governments should be strongly encouraged to prioritize both financial and human resources to ensure quality health services to benefit the general population
  • As new shorter, cheaper and better MDR-TB treatment is phasing in, consideration must be taken about accessibility by the most affected populations. 
  • The co-infection and interaction of TB and HIV infection should also be taken into consideration to ensure drug compatibility and toxicity for co-infected patients.
  • From previous experiences, pediatric regimens should also be fast tracked in accordance with the Sustainable Development Goal 3— Ensure healthy lives and promote well-being for all at all ages.

Dr ID Rusen, Senior Vice President, Research and Development at the Union, noted in a recent webinar that further investigations to find optimal regimens for patients need to be expedited. He also said that the potential impact of shortened treatment must be evaluated in programme settings by ensuring ability to uptake, manage and monitor the entire process. MDR-TB is caused by TB bacteria that are resistant to at least isoniazid and rifampicin, the two most effective TB drugs. Extensively drug-resistant TB (XDR-TB) is a severe form of MDR-TB that is also resistant to any fluoroquinolone and any of the second–line anti-TB injectable agents including amikacin, kanamycin or capreomycin.

According to WHO’s Global TB Report 2015, about 9% of MDR-TB patients develop XDR-TB, which is even more difficult to treat. Drug resistance to standard TB treatment is exacerbated by inadequate treatment, non-completion of treatment and person to person transmission. With more clinical studies on effective and patient friendly MDR-TB treatments going on in many countries, let us hope that the perfected Bangladesh regimen (as the shorter 9-12 month regimen is more commonly known) will be used more as norm, rather than as an exception.

Alice Tembe, Citizen News Service - CNS
June 29, 2016