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There is finally hope for people with multidrug-resistant tuberculosis (TB) and rifampicin-resistant TB (MDR/RR-TB), as newly discovered treatments promise to be more effective, shorter and with more manageable side effects.
Compared to the current 24-month treatment, Which?have?Proven to be ineffective in some cases, this new ?ConclusionThe TB treatment programme is expected to reduce the treatment period to nine months.
thoriumYeah?The new treatments, endTB1 (BLMZ), endTB2 (BLLCZ), endTB3 (BDLLZ), endTB4 (DLLCZ) and enTB5 (DMCZ), form part of a new regimen for MDR/RR-TB patients who “cannot take bedaquiline and/or linezolid.”
The World Health Organization (WHO) has not yet recommended and promoted an end-TB treatment approach?exist? Sanitary facilities.
A team led by Médecins Sans Frontières (MSF), Partners in Health (PIH) and Interactive Research and Development (IRD) formed the endTB consortium and began a phase 3 randomized controlled trial in 2017.
With funding from Unitaid, they evaluated the effectiveness and safety of five new shortened oral regimens for treating multidrug-resistant tuberculosis.
Unitaid is a global health initiative that works with partners to innovate to prevent, diagnose and treat major diseases in low- and middle-income countries, with a focus on tuberculosis, malaria, HIV/AIDS and their deadly co-infections. It was co-founded in 2006 by France, the United Kingdom, Brazil, Norway and Chile.
Kunda Kwabisha Mikanda, senior medical officer for MDR-TB and lead investigator for the End TB Lesotho trial, announced the development at a press conference last week. He explained that the current regimen they are trying to replace requires patients to take about 14,000 pills over 24 months.
If recommended by WHO, these new patient-centred regimens would allow clinicians to provide shortened MDR-TB treatment regardless of the MDR-TB patient’s age, pregnancy or common comorbidities, Dr Mikanda said.
He stressed that the current treatment regimen for multidrug-resistant tuberculosis requires up to 24 months of treatment, is only 59% effective, and often causes serious side effects.
“Currently used treatment options often cause serious side effects, including acute psychosis and permanent deafness. The newly discovered treatment option can provide nine months of treatment with manageable side effects,” said Dr. Mikanda.
The endTB trial involved 754 patients from seven countries: Lesotho, South Africa, Georgia, India, Kazakhstan, Pakistan and Peru.
“We are on the verge of a major breakthrough in the fight against multidrug-resistant TB, a disease that disproportionately affects poor people around the world. Our findings offer hope for those who urgently need treatment and highlight the urgency of continued research and innovation.
“MDR-TB has long been a daunting threat with limited treatment options and poor tolerability. Today, we published evidence for multiple innovative all-oral, shortened regimens that will enable personalized, patient-centered MDR-TB treatment. This marks a critical moment in the fight against this disease that afflicts vulnerable populations around the world. The new regimens will provide nine months of treatment with manageable side effects.”
Dr Mikanda said the new treatment regimen is expected to complement BPaLM, another treatment option recommended by the World Health Organization in 2022. He also noted that the trial results could address major barriers to treatment and that the endTB Coalition will continue to advocate for increased access to and affordability of quality TB treatment.
According to WHO estimates, approximately 410,000 people worldwide will develop multidrug-resistant or rifampicin-resistant tuberculosis (MDR/RR-TB) in 2022. Although treatment success rates for people with MDR/RR-TB have steadily improved, they remain alarmingly low. In 2020, the global treatment success rate was 63%, up from 60% in 2019 and 50% in 2012. WHO believes that poor management of TB treatment and human-to-human transmission are the main reasons for the emergence and spread of MDR/RR-TB. Most TB patients are cured with a 6-month treatment regimen (BPaLM) with adequate support.
WHO further states that inappropriate or incorrect use of TB medicines, ineffective drug formulations, substandard medicines, poor storage conditions and premature interruption of treatment can lead to drug resistance and subsequent spread, especially in crowded settings such as prisons and hospitals. According to current WHO policy, several treatment options are available for patients with MDR/RR-TB. Key factors in determining the choice of treatment include the patient’s drug resistance profile, previous exposure to TB drugs, the patient’s medical history, the drug resistance profile of close contacts, the patient’s age, the extent of pulmonary TB disease, and the location of extrapulmonary TB lesions.
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