New treatment puts big dent in deadly drug-resistant TB scourge
Shorter drug course is is having a huge impact in SA following a four-country landmark trial
A new treatment for multidrug-resistant tuberculosis, which is effective in just nine to 11 months, works just as effectively as the old 24-month course of medication, a new trial has shown.
The landmark STREAM trial was conducted in SA, Ethiopia, Vietnam and Mongolia, the New England Journal of Medicine says in a report released on Thursday.
Department of health figures show about 15,000 TB patients a year in SA contract multidrug-resistant TB, although this number is dropping with the use of new drugs.
STREAM shows that modern treatment of multidrug-resistant TB is a far cry from the past when headlines exclaimed that patients were “escaping” from multidrug-resistant TB hospitals.
Dr Paula Fujiwara, the scientific director of The Union, the international lung health collaboration that paid for the trial, said this was the best evidence yet to show that a shorter treatment works. “The final results from STREAM stage one are the first time we have ever had evidence on a shortened treatment for multidrug-resistant tuberculosis from a phase-three randomised trial.”
A randomised clinical trial is the highest form of scientific evidence, and is what many TB scientists wanted before using the treatment.
A total of 425 patients in SA, Ethiopia, Mongolia and Vietnam were given the short treatment and their medical results were compared with patients on the longer, older and more expensive treatment.
In SA, there were 145 trial participants, said principal investigator Francesca Conradie, from the Wits Health Consortium.
She said there had been concerns that the shorter treatment, which was initially used in Bangladesh, wouldn’t work as well with HIV patients.
“If it didn’t work in our population, then it was of no interest to South Africa at all.”
The trials began in 2011.
Conradie explained that “we wanted to know if people with HIV on this treatment were more at risk of relapse or did not get cured”.
What researchers found was that there were higher mortality rates in local patients, but that this was a result of having both MDR-TB and HIV, she said. However, it was not more difficult to treat HIV patients with drug-resistant TB using the new treatment, while ARVs didn't interfere with it.
Being part of the trial had helped SA “build clinical capacity” since there had been three trial sites in Johannesburg. Durban and Pietermaritzburg.
These sites were now being used for other TB drug trials.
Conradie said SA had already started using the shorter treatment for all MDR patients “because trials take a long time”.
The government had provided the treatment to all patients with the deadly disease.
However, it was good to have the study results and “the highest level of evidence that this treatment works”.
Conradie said the new treatment was already making an impact in SA.
“I don’t know if I would have adhered to the 24-month treatment,” she said.
On the older treatment only about 50% of patients were cured locally.
“The government is actively looking for MDR-treatment cases and the number is dropping by at least 1,000 a year.”
Conradie added that SA was a world leader in using bedaquiline, a new drug used to treat MDR-patients. It replaces an exceptionally painful injection that causes deafness in about 60% of patients.
It costs only R6,000 for a course of bedaquiline in SA, which is cheaper than the 24-month drugs.
“There have been 30,000 courses of bedaquiline given in the world and 20,000 of those have been in South Africa,” Conradie said.
“We [now] have a far more robust control of the drug- resistant TB epidemic. We are diagnosing fewer drug-resistant cases. We are actively looking for it, so we know we are not missing it. The number of cases is dropping.”