WHO gives hope to multidrug-resistant tuberculosis patients

Rapid diagnostic test and shorter, cheaper treatment signal new hope for multidrug-resistant tuberculosis patients, the World Health Organisation (WHO) said in a report.

The report made recommendations that aimed to speed up detection and improve treatment outcomes for multidrug-resistant tuberculosis (MDR-TB) through use of a novel rapid diagnostic test and a shorter, cheaper treatment regimen.

The report, which was made available by Christian Lindmeier, the WHO Communications Officer, to the Ghana News Agency on Friday, said at less than $1,000 per patient, the new treatment regimen could be completed in nine to 12 months.

It said not only was it less expensive than current regimens but it was also expected to improve outcomes and potentially decrease deaths due to better adherence to treatment and reduced loss to follow-up.

“This is a critical step forward in tackling the MDR-TB public health crisis,” Dr Mario Raviglione, the Director of WHO’s Global TB Programme, was quoted as saying.

“The new WHO recommendations offer hope to hundreds of thousands of MDR-TB patients who can now benefit from a test that quickly identifies eligibility for the shorter regimen, and then complete treatment in half the time and at nearly half the cost,” he said.

According to the report, conventional treatment regimens, which took 18–24 months to complete, yielded low cure rates: just 50 per cent on average globally.

It explained that this was largely because patients found it very hard to keep taking second-line drugs, which could be quite toxic, for prolonged periods of time and that “they, therefore, often interrupt treatment or are lost to follow-up in health services”.

“The shorter regimen is recommended for patients diagnosed with uncomplicated MDR-TB, for example those individuals whose MDR-TB is not resistant to the most important drugs used to treat MDR-TB (fluoroquinolones and injectables), known as ‘second-line drugs,” the report said.

It said it was also recommended for individuals who had not yet been treated with second-line drugs.

WHO’s recommendations on the shorter regimen are based on initial programmatic studies involving 1200 patients with uncomplicated MDR-TB in 10 countries.

WHO is urging researchers to complete ongoing randomised controlled clinical trials in order to strengthen the evidence base for use of this regimen.

The report said the most reliable way to rule out resistance to second-line drugs was a newly recommended diagnostic test for use in national TB reference laboratories.

It said the novel diagnostic test, called MTBDRsl, was a DNA-based test that identified genetic mutations in MDR-TB strains, making them resistant to fluoroquinolones and injectable second-line TB drugs.

It said this test yielded results in just 24-48 hours, down from the three months or longer currently required.

WHO reports that fewer than 20 per cent of the estimated 480,000 MDR-TB patients globally were currently being properly treated?.

It said the MTBDRsl test was also a critical prerequisite for identifying MDR-TB patients who were eligible for the newly recommended shorter regimen, while avoiding placing patients who had resistance to second-line drugs on this regimen (which could fuel the development of extensively drug-resistant TB or XDR-TB).

“We hope that the faster diagnosis and shorter treatment will accelerate the much-needed global MDR-TB response,” said Dr Karin Weyer, Co-ordinator of Laboratories, Diagnostics and Drug Resistance, WHO Global TB Programme.

“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,” she said.