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MDR-TB May Succumb to Shorter Treatment

  • Joe DeCapua

Phumeza Tisile, cured XDR-TB patient, South Africa. Credit: MSF

Phumeza Tisile, cured XDR-TB patient, South Africa. Credit: MSF

There’s encouraging news about treating multi-drug resistant tuberculosis, which killed about 210-thousand people last year. Preliminary data indicate a shorter, less painful treatment regimen is just as effective as current treatment that lasts one to two years. The findings were released at the 45th World Conference on Lung Health in Barcelona, Spain.

The World Health Organization estimates there were nearly a half-million MDR-TB cases in 2013. TB is considered multi-drug resistant if it’s not affected by two of the top drugs typically used to treat the disease.

I.D. Rusen is senior vice president for research and development for the International Union Against Tuberculosis and Lung Disease, or The Union for short. He said the number of cases does not tell the whole story.

“Very few of those cases are actually put onto treatment. So, maybe only 20-percent of the cases that are thought to occur actually get treated. And then the situation is even worse because of those who are treated only about half of them – or just under half of them – are treated successfully.”

He blamed the high rate of unsuccessful treatment on – what he calls—the “horrible” ordeal faced by MDR-TB patients.

“The treatment that’s available today is long. It’s grueling. It’s toxic. It’s really not an overstatement or an exaggeration. People are being treated for 18, at minimum, up to 24 months when they have multi-drug resistant tuberculosis. And included in that is for the first period of treatment daily – and then almost daily – injections. The injections are painful. And one of the major side effects of the injections is deafness, which can be permanent,” he said.

Patients are likely to quit treatment long before the prescribed length. However, preliminary data from two new studies show that type of treatment may become a thing of the past. Rusen described how the research began.

“This announcement stems from a pilot project that was done in Bangladesh. It really started several years ago where a shorter regimen of only nine months duration was used that showed really promising results – much better than what we see actually in the standard 24-month regimen. So what The Union has been trying to do is implement further studies to see if that really can be replicated elsewhere.”

That further research includes early data released at the Barcelona conference. The findings come from an observational cohort study conducted by The Union of one-thousand patients in nine West African countries.

The Union is trying to confirm those results with a study of one-thousand MDR-TB patients in West Africa.

Rusen said, “The other point that The Union is doing – it’s sort of a parallel approach – we’re undertaking a clinical trial, which is called STREAM, which is comparing this shortened regimen head-to-head with the standard 24-month regimen.”

For the STREAM study, The Union is collaborating with Treat TB Partner and the UK’s Medical Research Council.

The other study showing similar results for shorter treatment is being done by the Damien Foundation in Niger. Damien is the same group that conducted the pilot project in Bangladesh.

Rusen explained how nine-months of less painful treatment can be as effective – or more effective – than the one to two year program.

“It’s not the same drugs that are being used. But, interestingly, the nine-month regimen uses drugs primarily that have been around already. It’s using drugs that in some cases people were not convinced that they would work for tuberculosis or they weren’t people’s first choice. But they’re drugs that are generally less toxic or less difficult to take. [It’s a] tolerable regimen that people would be more likely to stick around and complete -- than necessarily the strongest medicine out there that might be too difficult to continue treatment with,” he said.

The nine month program also has daily injections, but Rusen said they would probably end after a few months. The goal is to introduce a regimen that has no injections.

He said if studies do confirm the preliminary results, the treatment success rate could rise from 50-percent to 80 or 90-percent.

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