Recommended Treatment Ineffective Against Resistant TB Strains
Madrid/New York, September 17, 1999 — A new study presented this week by Doctors Without Borders/Médecins Sans Frontières (MSF) shows that the currently recommended tuberculosis treatment strategy fails to have any impact on one in five TB patients in Siberian prisons. The research was presented at the 30th International Union Against Tuberculosis and Lung Disease (IUATLD) World Conference on Lung Health, an international meeting taking place in Madrid.
The study of 234 participants with TB was conducted by a MSF team in the Mariinsk Colony Penitentiary hospital in Siberia. It was designed to look at the effectiveness of the standard Direct Observed Treatment Short-course (DOTS) treatment regimen for TB recommended by the World Health Organization (WHO) and the IUATLD.
Although 75% of the patients in the study were cured through a well-administered DOTS program, 18% did not recover. This rate was very similar to the prevalence of MDR TB among the participants before treatment, which was 19%. Study analyses show that of those who failed treatment, 94% were infected with MDR TB.
"These results clearly show that, although the currently accepted treatment strategy can be highly effective, it does not cure patients who have multidrug-resistant TB (MDR TB), said Francine Matthys, M.D., of MSF. "It is unacceptable that patients are dying because they lack access to more potent, second-line treatments."
Optimal treatment of multidrug-resistant TB involves taking a combination of drugs for a minimum of 21 months. For the first three months, patients take a cocktail of five drugs. Their side effects are significant, and several of the drugs are under patent and extremely expensive. For patients in poorer countries, a more practical, affordable treatment protocol for MDR TB is needed.
The severity of disease in each patient and the level of resistance were quantified by diagnostics including sputum smears, cultures, drug sensitivity testing, and DNA finger printing. This testing was done before treatment, after three months of treatment, and at the end of treatment. All patients previously had been erratically treated, and thus were put on an eight-month re-treatment regimen. Final treatment outcomes were analyzed according to initial and new resistance patterns. Possible re-infection of patients under treatment was also monitored.
TB in Prisons Part of Larger Crisis
In some former Soviet Union countries, a collapsed health system and financial crisis have led to an irregular TB drug supply and inconsistent patient care. This has meant that many people do not finish their course of TB treatment. This situation stimulates the development of multidrug-resistant TB strains. The situation is worst in prisons, where patients are often infected with MDR TB.
MSF teams are currently supporting more than 20 TB programs worldwide, by helping to implement the WHO recommended DOTS strategy. However, the results of this study show that DOTS is not the complete answer for patients with MDR TB. In situations with a high prevalence of MDR TB, treatment strategies need to be adapted. Patients need to be tested for resistance before they begin treatment. If they are resistant, they need access to potentially life-saving second-line drugs.
MSF is the world's largest independent international medical relief agency aiding victims of armed conflict, epidemics, and natural and man-made disasters, and others who lack health care due to geographic remoteness or ethnic marginalization in more than 80 countries.