NEW YORK, 12th May, 2016 (WAM)–The World Health Organisation on Thursday recommended a significantly shorter and less expensive form of treatment for hundreds of thousands of patients world-wide with drug-resistant tuberculosis, a change that could help cure many more of them of the debilitating and difficult-to-treat disease.
The new recommendation calls for most patients with multidrug-resistant tuberculosis to be treated for nine to 12 months with antibiotics, replacing a current regimen that involves more drugs often more than 14,000 pills and lasts 18 to 24 months. The shorter regimen also costs far less: under $1,000 per patient in developing countries, compared with as much as $3,000 for the current treatment, the WHO said.
Patients’ eligibility should be determined with a newer, faster test that can diagnose which drugs a patient’s TB bacteria are resistant to within one to two days, replacing older tests that take three months or more to produce results, the WHO said.
“This is really a major advance,” said Mario Raviglione, director of the WHO’s global TB program. About 350,000 of an estimated 480,000 MDR-TB patients have bacteria that are treatable with the new regimen, he said.
An ancient disease, TB is still one of the world’s leading killers, claiming more lives every year than HIV/AIDS, though the two diseases are inextricably linked. The WHO says 9.6 million people were sickened with TB in 2014, and 1.5 million died that year. About 5% of all TB patients globally have MDR-TB, the WHO estimated; about 190,000 of them die every year.
Treatment for MRD-TB is notoriously difficult for patients; many of the drugs they must take have severe side effects that include hearing loss, kidney damage and psychosis. The new regimen still includes some of those drugs, but more people are able to finish treatment because they don’t have to take the drugs for as long, Dr. Raviglione said. “For the patient it’s a huge benefit,” he said.
While the new regimen is an advance, more needs to be done to develop even shorter treatments with newer, less toxic drugs, he and others said.
The WHO’s new recommendation was made based on data collected from observational studies of the shorter treatment in 10 countries, Dr. Raviglione said.
He said those data showed 84% of patients were cured, with only 6% failing to finish the treatment, known as the “Bangladesh Regimen” for the country in which it was initially tried. About 50% of patients are cured with the current treatment, and about a quarter of them fail to finish it, he said.
“It’s an enormous step forward, but there is more to do,” said I.D. Rusen, senior vice president of research and development for the International Union Against Tuberculosis and Lung Disease, which led studies of the use of the regimen in several African countries and is sponsoring a large clinical trial to evaluate its effectiveness. “Countries are not going to make the change unless the WHO gives the green light.”
“Patients with MDR-TB and those who treat them urgently need shorter, easier and more effective treatment regimens,” said Erica Lessem, director of the TB/HIV project at the Treatment Action Group, a research and policy think tank. “With new drugs in the pipeline for MDR-TB for the first time in decades, we also eagerly anticipate the development of further optimized regimens with fewer drugs, fewer side effects and better efficacy to develop a new standard of care for MDR-TB globally.”