22 Sep 16 12 Oct 17

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 480,000 people contracted multidrug-resistant tuberculosis (MDR-TB) in 2015, 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.

Tuberculosis treatment

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.

Patient story

Guldasta*, is an MDR TB patient and mother of one, from Nukus, Uzbekistan. She is a patient at the MSF supported hospital where one of the four trial sites for TB PRACTECAL is also based.

“When I was first diagnosed with TB, I felt like I couldn’t hear or see anything. I was in shock.

“I’ve experienced quite a lot of challenges during treatment but my only thought has been that I must get cured from this disease. I have one three-year-old son and he’s the only one that helps me get through this.”

* Name changed to uphold anonymity

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 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.

"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.”