Governments Must Step Up the Use of Newer Drugs to Fight Multidrug-Resistant TB

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Guadalajara, Mexico, October 13, 2017People with drug-resistant tuberculosis (DR-TB) are still not receiving two newer tuberculosis (TB) drugs, bedaquiline and delamanid, which have shown improved cure rates for the disease, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) at the 48th Union World Conference on Lung Health in Guadalajara, Mexico, where the global TB community is meeting.

Bedaquiline and delamanid, which received marketing authorization in 2012 and 2014, respectively, are the first new TB drugs developed in nearly 50 years. They represent a potential lifeline for people affected with the most resistant forms of TB, who face abysmal chances of being cured. And yet, MSF estimates that less than 5 percent of people who could benefit from the new drugs actually received them in 2016. MSF is concerned about the abysmally low uptake of the new drugs. Only 3,943 people received the two newer drugs in routine health care settings during the first half of 2017—a meager increase of 1,000 more people treated compared to the same period in 2016.

“Until five years ago, we had no treatment options and were forced to accept the risks of giving people a regimen containing DR-TB medicines that we knew had a slim chance of curing them. But what’s the excuse now for not using these drugs?” said Dr. Isaac Chikwanha, HIV and TB Medical Advisor at MSF’s Access Campaign. “Today, it’s unacceptable to continue treating [patients] with the same old regimen of medicines and not providing better treatment, knowing very well that we could be giving people a much better chance to stay alive by using these newer drugs.”

Tuberculosis is the world’s deadliest infectious disease, killing 1.8 million people each year. Current standard treatment for DR-TB requires people to take nearly 15,000 pills over two years, causes severe and debilitating side effects, and cures just one in two people. The two promising newer drugs were brought to the market with great hope they would form the backbone of new and dramatically-improved treatment for DR-TB.

“Delamanid gave me a second chance at life, and I wish that these tablets could be made available to the many people who are struggling with DR-TB,” said Sinethemba Kuse, who had extensively drug-resistant TB (XDR-TB) and was treated with delamanid in MSF’s project in Khayelitsha, South Africa. “There are so many people who are vomiting from the standard treatment at the moment, or crying from the injections, or even losing their hearing and dropping out of school or work.”

Globally, at least 30 percent of people with multidrug-resistant TB (MDR-TB) could benefit from the new drugs, according to estimates based on World Health Organization criteria. (Based on MSF’s field experience, this figure could go up to 70 percent in places where there is a high proportion of people with XDR-TB and with exposure to second-line drugs.) Yet, as of July 2017, only 10,164 people worldwide with DR-TB have received bedaquiline, and only 688 have received delamanid.

 “Use of bedaquiline and delamanid is currently limited for several reasons, including the fact that some national TB programs are too conservative,” said Dr. Chikwanha. “The pathetic rollout of newer drugs is unjust for people who now have a chance at effective treatment. The global TB community, governments, and donors must collectively take urgent steps to increase access to these two newer, promising drugs in order to save the lives of people with DR-TB.”

MSF has treated people with TB for 30 years. In 2016, MSF treated more than 20,000 people with TB, including 2,700 people with MDR-TB. As of June 2017, MSF, in partnership with national ministries of health, has started more than 1,500 patients in 14 countries on DR-TB regimens that include bedaquiline and/or delamanid.

Read the Report: Four Years and Counting: Slow scale-up of newer MDR-TB drugs covers less than 5 percent in need