MSF: New lifesaving TB drug pretomanid priced too high for people who need it

Simphiwe holds his medication, he takes up to 26 pills a day to treat XDR-TB. Here he holds his morning selection, which includes delamanid, one of the newest DR-TB drugs, which Simphiwe is taking for the first time today.

South Africa 2016 © Sydelle WIllow Smith/MSF

NEW YORK, HYDERABAD, INDIA, OCTOBER 30, 2019—The price of the new tuberculosis drug, pretomanid, the third new drug developed for tuberculosis (TB) in half a century, is too high for people who need it, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) Wednesday.

The drug is currently priced at $364 for a six-month treatment course, but pretomanid is just one part of a regimen of multiple drugs people with drug-resistant tuberculosis (DR-TB) need. MSF has called for the price of a complete DR-TB treatment course to be no higher than $500 per person.

Pretomanid was developed by the TB Alliance, a non-profit organization, and funded by the governments of Australia, Germany, the UK, and the US, as well as philanthropic sources. It is the first TB drug to be developed and approved as part of a ready-to-use treatment regimen (BPaL: bedaquiline + pretomanid + high-dose linezolid) for people with extensively drug-resistant (XDR-TB), people who can’t tolerate other treatment options, or those who with multidrug-resistant TB (MDR-TB) whose illness has not responded to other treatments. This new regimen has the potential to dramatically shorten treatment length to six months, greatly reduce the number of pills required, and help increase XDR-TB cure rates from an abysmal 39 percent.

In light of yesterday’s price announcement, the lowest global price for a six-month course of a ready-to-use regimen which includes pretomanid (BPaL) is $1,040. This is double the price MSF is calling for in a complete DR-TB treatment course. 

This price was set despite the fact researchers from the University of Liverpool have estimated that generic versions of pretomanid could be produced and sold at a profit for less than $1.35 a day, or less than $35 a month.

The high price of one of the other newer TB drugs, bedaquiline, at $400 for a six-month treatment course, will also impede the uptake of the BPaL regimen in high TB burden countries.

MSF has launched a global campaign calling on pharmaceutical corporation Johnson & Johnson (J&J) to lower the price of its drug bedaquiline to no more than $1 per day, which is $200 for six months—half of what J&J currently charges.

Furthermore, TBA must also support or carry out research to address outstanding medical questions concerning the safety and efficacy of its drug independent of the BPaL regimen and in comparison to another drug in the same class, as well its suitability for different populations including children, pregnant women, and people living with HIV receiving the antiretroviral dolutegravir since many people with HIV are co-infected with TB.

Sharonann Lynch, HIV & TB policy advisor for MSF’s Access Campaign, said the following about the high price:

“Newer TB drugs, including pretomanid, may have tremendous potential for tackling difficult-to-treat drug-resistant forms of TB, but only if they are affordable. The high price of this drug could have a chilling effect on its uptake in high TB burden countries.

“We are calling on Mylan and the TB Alliance to bring the price of pretomanid down much further so the TB Alliance can hold true to its stated mission of developing and making improved TB medicines accessible to people who need them.

“After half a century, we finally have new TB drugs that can offer a better chance of survival for people who otherwise continue to die from the world's leading infectious disease killer. The public helped pay for the development of this drug, and, therefore, this drug should be affordable and accessible to anyone who needs it. What good is a lifesaving drug if the people who need it can’t afford it?”