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Better treatments urgently needed
Drug-resistant tuberculosis (DR-TB) is a major global health emergency. TB now ranks alongside HIV as the world’s most deadly infectious disease, according to the World Health Organisation’s latest global statistics.
An estimated 600,000 people contracted rifampicin-resistant tuberculosis or multidrug-resistant tuberculosis (MDR-TB) in 2016, yet only around one quarter of them were diagnosed and started on treatment. Meanwhile resistant strains continue to transmit from person to person.
The latest Global TB Report records rates of more than 20 percent MDR-TB amongst newly diagnosed TB cases in parts of Eastern Europe and Central Asia, rising to a staggering 69 percent in re-treatment cases.
Efforts to control the epidemic are dangerously out of step with international recommendations and proven best practices, hampered by political, financial and technical obstacles. The standard treatments today present a significant challenge to scaling up the necessary global response.
Today most DR-TB patients worldwide still face two years or more of toxic treatment, including painful injections and thousands of pills, in a regimen that costs US$1,500-5,000 per treatment course.
Meanwhile cure rates for pulmonary MDR-TB remain obstinately stuck at 50 percent. This is in-spite of the long awaited arrival of new TB drugs some three years ago.
Better TB care
People with TB, their families, communities and medical staff worldwide are calling for better treatment!
An MSF DR-TB patient blog, ‘TB&ME’, exposes the difficulties faced by people undergoing treatment and the sheer determination and courage necessary to make it through to the end.
Cured MDR-TB patient and TB doctor Wubshet Jote Tolossa says: "Going through TB was tough. But so was I. When I started treatment for the second time, the side effects were difficult but I could tell they were helping me recover. I took injections with around 20 tablets daily for nine months. And tablets only for two years.
"Unfortunately the new drugs I had are not available to everyone and now, as a doctor, I see patients struggle everyday. We should all play our part to get rid of TB, for good."
To read more experiences from people going through DR-TB treatment visit our TB&ME patient blog.
New TB drugs
Finally, after years of waiting, MSF spotted that an opportunity to revolutionise DR-TB treatment and turn the crisis around.
A number of new anti-TB drugs – bedaquiline (TMC207; B), delamanid (OPC-67683, D), pretomanid (PA-824; Pa) and repurposed ones – oxazolidinones, including linezolid (Lzd) – have become available, albeit too slowly.
Each drug acts upon a novel target in the tuberculosis bacilli with the potential to be highly effective, especially when used in combination. Promising evidence is emerging from stage II trials exploring combinations of existing anti-TB drugs with individual new drugs, and from stage III trials exploring shortened existing TB treatments.
However, to date there are too few initiatives underway to explore combinations of the new drug classes used together, along with the best existing drugs, in order to maximise the potential of developing a radically improved treatment regimen.
This is why MSF decided to run a full phase III clinical trial ourselves.
"MSF and partners refuse to stand by and watch patients suffer whilst new treatments remain years away," says Dr Bern-Thomas Nyang'wa, Project Manager & Chief Investigator, TB-PRACTECAL.
"Instead, we are seizing the opportunity to look for new and radically improved treatment combinations that answer the needs of patients first and foremost.”