The World Health Organisation (WHO) hopes to see major improvement in treatment outcomes and quality of life of patients with multidrug-resistant tuberculosis (MDR-TB) following changes in the treatment regimes.
The first important change is a new priority ranking of the available medicines for MDR-TB treatment, based on a careful balance between expected benefits and harms. Treatment success for MDR-TB is currently low in many countries. This could be increased by improving access to the highest-ranked medicines for all patients with MDR-TB.
The second important change is a fully oral regimen as one of the preferred options for MDR-TB treatment, with injectable agents proposed to be replaced by more potent alternatives such as bedaquiline (the first-ever medicine to be developed specifically for the treatment of MDR-TB). Injectable agents cause pain and distress to patients, with many experiencing serious adverse effects that often lead to treatment being interrupted, a statement issued by WHO has said.
“The treatment landscape for patients with MDR-TB will be dramatically transformed for the better with the announcement,” said Dr Soumya Swaminathan, WHO Deputy Director-General for Programmes. “Building on the available new data, and with the involvement of a large number of stakeholders, WHO has moved forward in rapidly reviewing the evidence and communicating the key changes needed to improve the chances of survival of MDR-TB patients worldwide. Political momentum now needs to urgently accelerate, if the global crisis of MDR-TB is to be contained,’’ she said.
The WHO rapid communication aims to encourage and prepare countries to implement the upcoming new consolidated, updated and more detailed WHO policy guidelines on MDR-TB treatment which will be released later this year. WHO is also establishing a multi-stakeholder Task Force to coordinate support to national TB programmes in their rapid transition to the key changes envisaged.
The announcement follows an in-depth assessment of the latest evidence on the efficacy and safety of medicines available to treat MDR-TB by an independent panel of experts convened by WHO. The outcomes of the meeting, held 16-20 July, also have major and immediate implications for countries, donors and technical partners as clinical care, national diagnostic and treatment policies, medicine and diagnostic procurement strategies, and training plans will require rapid review and adaptation.
TB is among the oldest diseases known to mankind, yet remains one of the top 10 causes of death worldwide today, as well as the leading global infectious disease killer. About 600,000 new cases of MDR-TB (or other rifampicin-resistant TB) emerge each year and about 240,000 people die of these forms of TB each year according to WHO estimates.
MDR-TB is a major driver of antimicrobial resistance worldwide and threatens hard-earned gains made in the global TB response over the past twenty years. Diagnosis and treatment of MDR-TB remain a major challenge, with only one in four affected people currently being detected and even fewer being treated successfully.
Heads of State, Government and other global leaders are also meeting at the first-ever United Nations High-level Meeting on TB in New York on 26 September 2018.