WHO: Cutting multidrug-resistant TB treatment time in half would save more lives

An Indian doctor examines a tuberculosis patient in a government TB hospital. (AP Photo/Rajesh Kumar Singh)

The World Health Organization issued a new recommendation to cut the treatment time for people with multidrug-resistant tuberculosis in half. The cut should help reduce overall treatment costs, reach more people and likely save more lives. The U.N. health body also said that a novel rapid diagnostic test to identify drug resistance should be used. It means near immediate change for the estimated 480,000 people living with multidrug-resistant tuberculosis (MDR-TB) around the world.

“We hope that the faster diagnosis and shorter treatment will accelerate the much-needed global MDR-TB response,” said Karin Weyer, coordinator of laboratories, diagnostics and drug resistance, WHO Global TB Program, in a statement.  “Anticipated cost-savings from the roll out of this regimen could be re-invested in MDR-TB services to enable more patients to be tested and retained on treatment.”

Patients currently being treated for MDR-TB undergo a drug regimen spanning 18 to 24 months. The drugs are tough physically and must be taken at frequent intervals. As a result, patients with MDR-TB may opt not to seek treatment at all or not adhere to dosage recommendations. All that contributes to an average 50 percent cure rate.

The new recommendation by the World Health Organization (WHO) cuts the treatment time down to between nine and 12 months. It is only applicable to patients that do now show resistance to the best MDR-TB drugs and those yet to be treated with them. Studies in 10 countries showed the promise of shortening treatment and are the basis for the WHO recommendation. In Bangladesh, cure rates jumped to about 85 percent when the shorter treatment was tested.

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Doctors Without Borders conducted its own short-course regimen study in Uzbekistan and Swaziland. David Lister, a TB doctor who led the Uzbek study found that the time horizon change made a big difference for patients. He saw parents hide their sick children to avoid two years on MDR-TB drugs. But the shorter treatment led to better buy-in.

“The fear of relentless suffering due to side effects manages to outweigh any hope of cure or returning to a normal life,” he said in a statement. “But when I tell patients that it’s only nine months of treatment, they respond, ‘I can do that.’”

Additionally, the use of the DNA-based MDR-TB diagnostic test let’s healthcare providers know if a person with TB has a drug-resistant form in less than 48 hours – significantly less time than the three months it takes for traditional tests. This would lead to a quicker treatments start, prevent the use of unnecessary of ineffective drugs, and help ensure that the number of people with MDR-TB receiving proper treatment exceeds the current rate of less than 20 percent.

As a result of the change, costs will also be halved. The WHO estimates that it will cost less than $1,000 per patient for the new timeline. It is a savings that increases access to patients living in developing countries and allows global TB funding to go further. More research will help better understand how to hone the treatment.

Those savings will get some help thanks to a new deal negotiated by the Stop TB Partnership to cut the price of the MDR-TB drug linezolid by about 70 percent. That will lead to a savings of as much as $30 million over the next three years. The companion drug will help more people access the life-saving MDR-TB drugs bedaquiline and delamanid. However, with only 2 percent of people in need of those drugs gaining access, there is a long way to go in terms of improving pricing.

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It is expected that the WHO will soon release new guidelines on the management of MDR-TB. The shorter treatment time and use of the rapid diagnostic test will be a part of the larger policies that help guide countries affected, which tend to be developing countries. Stopping the spread of MDR-TB will require efficient treatment, adequate resources, and effective drugs.

Both bedaquiline and delamanid are relatively new drugs. Some new drugs are in the development pipeline, but progress remains slow in the face of spreading resistance and the emergence of extremely drug-resistant forms of TB. That is why Doctors Without Borders infections disease specialist Philipp du Cros called attention to the need to support research and development.

“Ultimately, we can’t lose sight of the desperate need for completely new treatment regimens that work for all people with drug-resistant TB and that completely eliminate the old, toxic drugs still used in these shorter regimens, particularly the daily painful injections that people must endure,” said Cros, in a statement.

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Tom Murphy

Tom Murphy is a New Hampshire-based reporter for Humanosphere. Before joining Humanosphere, Tom founded and edited the aid blog A View From the Cave. His work has appeared in Foreign Policy, the Huffington Post, the Guardian, GlobalPost and Christian Science Monitor. He tweets at @viewfromthecave. Contact him at tmurphy[at]humanosphere.org.