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Scientists release results of innovative trial
In the lead up to World Tuberculosis Day, which falls on March 24, a group of international scientists released the results of a clinical trial for the standardized treatment of multidrug-resistant tuberculosis (MDR-TB) that might significantly reduce treatment time and the costs associated with it
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span>In the lead up to World Tuberculosis Day, which falls on March 24, a group of international scientists released the results of a clinical trial for the standardized treatment of multidrug-resistant tuberculosis (MDR-TB) that might significantly reduce treatment time and the costs associated with it.
The trial for Stage 1 of the Standardized Treatment Regimen of Anti-TB Drugs for Patients with MDR-TB (STREAM) has shown that a regimen lasting nine to 11 months is effective in treating forms of TB that are resistant to first-line antibiotics isoniazid and rifampicin.
These two drugs were used to treat an estimated 485,000 people worldwide in 2017, according to the World Health Organization’s (WHO) 2018 Global Tuberculosis Report.
Patients with MDR-TB must usually take medication for 20 to 24 months, a costly procedure that has significant side effects and is hard on both patients and the health system.
Andrew Nunn, a STREAM co-chief investigator from the University College of London, said: “We know from programmatic data that the 20 to 24-month regimen has a number of major drawbacks, including the difficulty of completing such a long treatment, the significant side effects of the drugs used and poor treatment outcomes.
“Shorter, more effective and safer regimens are urgently needed.”
Worldwide, TB is one of the top 10 causes of death. According to the WHO report, the disease caused an estimated 1.3 million deaths in 2017.
Indonesia ranks second after India for most TB cases. The Health Ministry revealed that the TB incidence rate in Indonesia is 1.02 million cases per year. In 2017 alone, the rate was 391 cases per 100,000 people.
Even so, Indonesia has made great progress in expanding TB control in the last few years, with major assistance from donors such as the Global Fund against AIDS, TB and Malaria (GFATM) and United States Agency for International Development with its TB Care program. Despite the steps forward, Indonesia still faces many challenges to ending TB by 2030, including those related to MDR-TB such as the availability of and access to treatment for patients with MDR-TB.
The estimated economic burden of TB in Indonesia according to a report by TB Care that collated national data from 2011 was roughly US$2.1 billion.
“A shorter duration of less medication is a clear advantage to the patient and increases the likelihood that the treatment is completed, with an earlier return of the patient to work and social activities,” said Paula Fujiwara, the scientific director of the Paris-based International Union against Tuberculosis and Lung Disease, in a statement sent to The Jakarta Post.
“We look forward to the analysis of the health economic data exploring the potential cost savings of the nine to 11-month treatment for both patient and health systems compared to the 20 to 24-month medication.”
The union’s statement was made available prior to the publication of the clinical trial results in The New England Journal of Medicine on Wednesday.
“In line with the updated WHO MDR-TB treatment guidelines published in December 2018, The union will continue to support the appropriate use of a shorter period of medication in conditions where patients are monitored closely throughout treatment, particularly with regard to hearing loss — a potential adverse effect,” Fujiwara added.
The STREAM trial is jointly sponsored by The Union and Vital Strategies with key global partners, including the Medical Research Council Clinical Trials Unit at the UCL, the Liverpool School of Tropical Medicine and the Institute of Tropical Medicine.
