TB treatment guidelines get a complete overhaul

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Several new medicines are more effective than traditional ones used to treat multidrug-resistant tuberculosis (MDR-TB), a new study reports.

The new research has led the World Health Organization to announce landmark changes in line with the study’s findings.

Tuberculosis is among the top 10 causes of worldwide deaths and the leading global infectious disease killer. Approximately 600,000 cases of MDR-TB emerge each year, claiming 240,000 lives.

Diagnosis and treatment remains a major challenge with only one in four affected patients receiving a diagnosis and even fewer getting successful treatment. Present treatment practices of MDR-TB use expensive, antiquated drugs that lead to toxic side effects including constant nausea, hearing loss, and renal failure.

New drugs

For the new study, which appears in The Lancet, researchers combined the data of over 12,000 patients with MDR-TB from 50 studies conducted in 25 countries.

By compiling such a large amount of data, they were able to determine that new TB drugs such as bedaquiline, linezolid, and the later generation fluoroquinolones consistently demonstrated better cure rates and reduced mortality compared to currently used treatments for people with MDR-TB.

“The guidelines committee simply erased the old treatment recommendations and started over.”

The new drugs were also effective in treating XDR-TB (extensively drug-resistant TB). Further, daily injections for treating MDR-TB may no longer be necessary (except in the most serious of cases).

The WHO’s new treatment guidelines recommend the new MDR-TB regimen and also position fully oral regimens over injectable agents.

“The guidelines committee simply erased the old treatment recommendations and started over. They gave the treatment guidelines a complete makeover,” says Dick Menzies, senior scientist at the Research Institute of the McGill University Health Centre (RI-MUHC).

Wholesale changes

A committee responsible for making recommendations about treatment of MDR-TB with representatives of the American Thoracic Society (ATS), Centres for Disease Control and Prevention (CDC), European Respiratory Society (ERS), and Infectious Disease Society of America (IDSA) have also considered this new information.

“Although these guidelines are not yet finalized, I believe this committee will make similar wholesale changes to the way MDR-TB is treated,” says Menzies, who is also a senior scientist from the Translational Research in Respiratory Diseases Program and a professor of medicine, and of epidemiology and biostatistics.

“Given that each of these new drugs may increase cure rates by as much as 10 percent, we hope that the new combinations will result in cure rates of up to 90 percent—which would be extraordinary,” Menzies says.

“The results confirm what TB clinicians around the world are seeing with their own eyes,” says Paul Farmer of the global health and social medicine at Harvard University.

“It’s our hope that after 20 years of recommending these toxic regimens… we can finally turn to new and safer therapies based on demonstrably safer and better tolerated drugs.”

Source: McGill University