Great strides in MDR-TB treatment

Alice Tembe, CNS Correspondent, Swaziland
Final results of a potentially game-changing study on a nine-months treatment regimen for multi-drug resistant TB (MDR-TB) were announced at the 47th Union World Conference on Lung Health in Liverpool, UK. This study  carried out in nine Francophone countries has shown a treatment success rate of 82% with limited adverse side effects - a significant stride towards stopping TB.

The study was conducted in Benin, Burkina Faso, Burundi, Cameroon, Central Africa Republic, Cote d’Ivore, Democratic Republic of Congo, Niger and Rwanda. This novel treatment regimen for MDR-TB is a great improvement over the current 24 months (or more) long treatment, which has a treatment success rate of 52%.

These encouraging results assume greater significance in the light of the fact that MDR-TB remains a public health crisis. WHO estimates that 580,000 people became sick with TB resistant to at least rifampicin in 2015, of whom 480,000 were diagnosed as having developed resistance to both rifampicin and isoniazid. Detection and treatment gaps continue to plague the MDR-TB response. Even for those one in five people newly eligible for second-line treatment who were able to access it, cure rates continue to remain low at 52%.

The final results from this observational study conducted on 1006 rifampicin resistant TB patients show that 821 patients were treated successfully, indicating a high cure rate of 82%. It was also noted that 734 patients completed  the full course and tested negative for the presence of TB bacteria three times before completion, using culture test. An additional 87 patients successfully completed the full course of treatment without demonstrating any signs of treatment failure but had less than three negative culture results. 54 patients (5%) did not respond to the treatment, 82 patients (8%) died, and 49 (5%) were lost to follow-up. The death rate was higher among patients with HIV-infection, but among patients who survived, the regimen demonstrated similar success rates in HIV-infected and non HIV-infected patients.

The new regimen has another added advantage in so much as it involves giving injectables only for 4 months, as compared to the 6-8 months in the current 24 month regimen, thus reducing the extent of side effects, noted Dr Bertie Squire, past President of the International Union Against Tuberculosis and Lung Disease (The Union) and Professor at the Liverpool School of Tropical Medicine. 

Ms Phumeza Tisile
The first female extensively drug resistant TB (XDR-TB) survivor from South Africa Ms Phumeza Tisile, shared that when she got sick there was no GeneXpert or the new age drugs that are becoming available now. She was just put on treatment and for the first 6 months she continued having sputum positive test results. Expressing gratitude for the introduction of Bedaquiline and Delamanid, Ms Tisile explained that the experts in the TB field should need to amend the language used while referring to patients with TB, that is derogative and sometimes indicative of criminal offense. This will also help to improve the way society treats people living with TB. Some of these terms include, but are not limited to, the following:
  • TB suspect: this seems as if patients are criminals of some sort. It would be better to say ‘people to be evaluated for TB’
  • Research subjects: this tends to degrade and dehumanise the person. We could rather use the words ‘research participants’
  • Treatment defaulter: this term could be replaced with ‘a person who did not complete the course of treatment’
The new shortened treatment regimen is indeed a major milestone response to the United Nations General Assembly commitment to act globally against drug resistance. It is therefore essential to applaud this giant step while urging the next steps of accelerating countries’ responses for making the new regimen available for patients eligible for it. It is critical for governments now to make fiscal commitments putting in place systems and structures for drugs procurement and distribution, updating policies and guidelines, and training health personnel to enable implementation of the new regimen.

‘With strong evidence now showing that this is the most effective available regimen for treating multi-drug resistant forms of TB, the next step is for countries to begin widely implementing this new approach,” said Dr Arnaud Trebucq, a senior consultant with The Union. Valerie Schwoebel, Programme Manager at The Union for Francophone Africa added that the cost of treatment drugs in the new regimen is likely to be reduced to approximately $1000 per patient from the previous long term cost of US$3000 per patient - a reduction of 33% - even without considering the added elongated cost of care and loss of income for the patient in the current 24 month long regimen.

Alice Tembe, CNS Correspondent, Swaziland 
27 October 2016  
(Alice Tembe is providing thematic coverage from the 47th Union World Conference on Lung Health in Liverpool, UK, with kind support from Lilly MDR TB Partnership. Follow her on Twitter: @Tembe3)