A faster, simpler cure for TB will save millions of lives and have tremendous global benefits. A shorter TB regimen could improve treatment compliance, stop the spread of drug-resistant tuberculosis, and enable the global scale-up of MDR-TB treatment. A shorter and simpler treatment will not only help cure those currently under care, but will also allow health workers to reach more people by reducing the burden on national TB programs.
Treatment for active, drug-sensitive TB consists of 4 medicines (known as first-line drugs) and is administered for a period of 6 to 9 months. In clinical trial settings, this regimen is effective. However, when administered in real-world settings, the regimen's flaws become very apparent.
The long and complex regimen is burdensome for patients, even when taken under direct observation by a healthcare worker or community member, as recommended by the WHO. As a result, many patients do not or cannot complete their treatment, which leads to the development of deadlier drug-resistant strains. While drug-resistant TB is a man-made issue, research has shown that those strains are now being transmitted from patient to patient.
New, faster and better
drugs are urgently
needed to defeat TB
Drug-resistant TB is difficult, complicated, and expensive to treat. Treatment relies on second-line drugs, and is commonly administered for 2 years or longer. It includes daily injections, and often causes severe side effects. Most endemic countries lack the financial, human, and infrastructural resources to treat drug-resistant TB. There are an estimated 650,000 MDR-TB patients today, yet fewer than 50,000 patients receive treatment. Of those who do, nearly half will still die. What's worse, some resistant strains are virtually untreatable with any existing antibiotics.
Further, the current TB drug regimen is not compatible with certain common antiretroviral (ARV) therapies used to treat HIV/AIDS. To avoid drug-drug interactions in co-infected patients, the treatment regimen for one of the diseases must be suboptimally modified. This poses a massive challenge to controlling these twin epidemics, given that an estimated one-third of the 40 million people living with HIV/AIDS worldwide are co-infected with TB. The deadly synergy of these two diseases demands first-line treatments that can be fully harmonized.
In most endemic countries, US$20-40 will buy a full six-month drug course of TB treatments and many national TB programs provide first-line drugs free to patients. But even where TB drugs are available to those in need, the length of treatment places an undue burden on patients. TB affects mainly the poor — those who can least afford frequent visits to health clinics, additional transportation costs, and lost work hours.
Building on and enhancing Directly Observed Therapy Short Course (DOTS), the internationally recommended strategy for TB control, in 2006, the WHO adopted the Stop TB strategy to dramatically reduce the global burden of TB by 2015. Combating TB is also recognized as a priority under the United Nations' Millennium Development Goals.
The research and development of new medicines is an integral part of a comprehensive TB control plan.
Without new and improved TB treatment regimens, including treatment for those suffering from drug-resistant TB and co-infected with HIV/AIDS, the reduction and eventual eradication of the disease cannot be achieved.