By Francis Okoye
Patients suffering from Multi Drug Resistant Tuberculosis known as MDR TB, now have hope of a better cure with a new treatment recently approved by world Health organization.
According to WHO global TB programme,new WHO recommendations aim to speed up detection and improve treatment outcomes from multi drug resistant Tuberculosis,MDR TB,through use of a novel rapid diagnostic test and shorter,cheaper treatment regime,at a cost of $1000 per patient and would be completed in 9 -12 months-The treatment is less expensive than current regime,and it is expected to improve outcomes and potentially decrease death due to better adherence to treatment and reduced loss to follow up.
With the development ,accurate and early diagnosis along with shorter cheaper and more effective treatment can help countries deliver on their promise to end TB by 2013 or earlier(sustainable development goal 3.3)
According to experts,rapid diagnostic test and shorter cheaper treatment signal new hope for MDR-TB patients.
Medical experts speak on the issue
In a webinar organized for the media by Citizen News Services on shorter,cheaper and possibly better MDR TB treatment,experts including DR I D Russen, Senior Vice President,research and development at International Union Against Tuberclosis and lung Disease,Dr Fuad Mirzayer,Medical Officer at laboratories Diagonostic and Drug resistant unit,WHO Global Tuberclosis programme,Dr Sunil khaparde,Deputy Director General Central TB division,Ministry of Health and Family welfare,Government of india,Shobha Shukla ,co moderator and managing Editor citizen news service,and Ashok Ramsarupp-moderator of webinar from south Africa broadcasting corporation, presented the webinar to health writers around the world.
According Dr Rusen,who leads Treat TB Initiative which coordinated the STREAM clinical trials for shortened MDR TB treatment regime: MDR TB treatment and burden and treatment limitations, WHO recorded 480,000 new MDR TB cases in 2014,only ¼ detected and treated,with only 50% treated successfully.Current treatments are lengthy and often difficult to tolerate, hence more accessible and tolerable treatment for TB is needed.
Experience from Damian foundation in Bangladesh 9 months success(Bangladesh regime) recorded 82.5% cure with 5.8% default.5.3% deaths,).5 %failure and 0.5% relapse with 87.9% success in the new shorter regime treatment.
In another clinical trial,408 patients were used with a modified Bangladesh regime in west Africa-9 Countries including Benin,Burkina Faso,Burundi,Cameroon,Central Africa Republic,Cote d”ivore,DR Congo,Niger and Rewanda,it recorded 82.1% success in treatment of MDR TB,the rest were defaults and patients running away.
Other randomised controlled trial of non inferiority design in stage 1 and stage 2 have also kicked off,with fully oral 9 months regime and 6 months simplified regime,numerous clinical research studies planned are underway and can be found on www.resistb.org
WHO treatment guidelines for drug resistant TB 2016 update
Dr Fuad Mirzayer who spoke on WHO Treatment guidelines for drug resistant TB 2016 update said that a shorter regime is recommended with clofazimine/linezolid as core second line Medicine in MDR TB and PAS as add ion.MDR TB treatment is recommended for patients with RR tuberculosis regardless,if Isoniazid resistance or MDR resistance. If exposure ineffective, use of individual conventional MDR TB regime is recommended ie in pregnancy, intolerance or exposure.
The implications of the recommendations is that most patients would want the new treatment, clinicians would want most individual s to receive the intervention and policy makers can adopt the policy.Further research is very unlikely to change the confidence of WHO in estimate of the effectiveness of the new drug.
A current use of the shorter TB regime in 10 countries involving 1,205 patients recorded 84% success,7% did not complete treatment,6% lost to follow up and 3% failure of treatment. The MDR TB regime can apply to children ,adults and PLHIV but are not recommended for people with extra pulmonary disease or pregnant women.
Dr Sunil Khaparde recounted Indians experience with the new shorter TB regime and lessons learnt.In the question and answer segment ,experts answering whether HIV patients were involved in the clinical Trials said that in the west Africa clinical Trials(stream cohort) of the 91 MDR TB patients that received treatment,74%of them were HIV positive,18 % died in that treatment.
Multi drug resistant TB
According to WHO publication on guidelines for workplace Tb control activities-The contribution of the workplace Tb control activities to TB control in the community,page 27,no24”muliti Drug resistant TB is caused by inconsistent ,partial or incorrect treatment of TB, Multi drug resistant TB(MDR TB) is a specific form of drug resistant TB ,with resistant to at least isoniazid and rifampicin,the two most essential TB drugs.It is possible to treat MDR TB but only with expensive and potentially toxic treatment lasting up to 2 years.
However ,hope on the new, shorter and successful treatment for MDR TB is now with us .Will countries and decision makers in most developing countries with high burden of TB make use of the opportunity by adopting the WHO recommended new MDR TB treatment. Only time will tell.
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