Towards a TB-free world: Shorter MDR-TB regimen

Dr Richa Sharma, Citizen News Service, India
The world is no stranger to the deadly TB phenomenon and has been equally terrified of the magnanimous proportion of MDR-TB cases that are being reported globally. MDR-TB is a form of TB in which the bacteria develops resistance to at least isoniazid and rifampicin—the two most powerful antimicrobial drugs used to treat ordinary TB.

Incorrect use of drugs, use of ineffective drug formulations, and interruption of the drug sensitive TB treatment often leads to MDR-TB, which then further spreads through direct person to person transmission.

WHO estimates there are 4,80,000 MDR-TB cases globally. In a webinar hosted by CNS, Dr ID Russen, (Senior Vice President, Research and Development, The Union) highlighted that of the total 4,80,000 MDR-TB cases, only a quarter are detected and treated and that only 50% of those treated are cured successfully. There are a myriad of reasons that make MDR-TB difficult to treat: longer treatment duration, high cost of drugs, treatment interruption and/or non adherence to complete treatment due to adverse side effects caused by high toxicity of the drugs. In a worst case scenario, MDR-TB may give rise to extensively drug-resistant TB (XDR-TB)—a more severe form of TB, which is additionally resistant to more TB drugs.

As one of the means to ending TB by 2030, described under Sustainable Development Goal 3, WHO has recently recommended the use of shorter MDR-TB regimen. Dr Fuad Mirzayev (Medical Officer, Laboratories, Diagnostics and Drug Resistance Unit, WHO Global TB Programme) in the webinar elaborated on the features of this regimen saying that it is cheaper; of a shorter duration; and in which medicines have been regrouped. Evidence informed recommendations on the role of surgery have also been made under the new regimen. This sounds like much awaited God sent news for the patients as well for the healthcare providers as it is bound to improve treatment outcomes in MDR-TB cases. However, Russen also added that this regimen may require further evaluation with testing for impact of new medicines in different populations and it may also depend on the capacity of the programmes to participate in research efforts. India has a very high burden of TB cases— 2.2 million TB and 72,000 MDR-TB cases every year.

Dr Sunil Khaparde (Deputy Director General of Revised National TB Control Programme, Ministry of Health and Family Welfare, India) in the same webinar stressed on the fact that the non adherence to the prolonged treatment for MDR-TB is also a result of a few socio-cultural issues in the Indian society. He said that accessibility to the medicines remains a big challenge in India owing to the difficult geographical terrain in certain regions. Additionally, the long treatment may mean loss in daily wages of the labour population which often discourages them from adhering to treatment . He stated that this shorter regime will be a rational step for the Indian population as it may lead to better cure results. Another very interesting and note worth point from the webinar was about inclusion of paediatric population suffering from TB in such research efforts as both diagnosis and treatment in this population often remains a challenge for the public health professionals. With the new shorter, effective drug regimen for MDR-TB, we can hope and wait for a world free of this deadly disease, thus sparing millions of people from its debilitating, and at times fatal, outcomes.

Dr Richa Sharma, Citizen News Service - CNS
July 6, 2016