New drugs, new hope
In December 2018, the World Health Organization announced new recommendations for the treatment of multidrug-resistant TB (MDR-TB), a form of the disease that is resistant to the two most powerful ﬁrst-line TB drugs. According to the announcement, fully oral treatments should become the preferred medication option for most patients, and injectable agents are no longer among the priority medicines to be considered when designing longer treatments for MDR-TB. In particular, kanamycin and capreomycin—drugs known to cause severe side effects—are no longer recommended. Instead, the guidelines urge the use of newer, more potent drugs like bedaquiline and delamanid for all adult MDR-TB patients.
The WHO ﬁrst recommended use of bedaquiline for treatment of drug-resistant TB in 2013. But uptake of it and other new TB drugs remains very slow, with the lifesaving medicines still inaccessible to almost 90 percent of people worldwide who could have beneﬁted from them in 2017.
In Ukraine, bedaquiline was registered in June 2018, while delamanid was registered in January 2019. MSF was one of the ﬁrst organizations to offer these drugs to patients in Ukraine, and has been outspoken about the importance of expanding access to them. All new patients in the MSF pilot project in Zhytomyr are now prescribed oral TB drugs only, and we hope to see these guidelines become the standard in Ukraine and beyond.
MSF is one of the largest nongovernmental providers of care for patients with TB, which remains the deadliest infectious disease worldwide. In addition to providing DR-TB treatment in various countries, MSF conducts research with partner organizations to develop the evidence base for the therapeutic value of newer treatments. Our Access Campaign is also calling for these essential medicines to be more affordable and more widely available, and for greater research and development efforts to focus on treating DR-TB as a priority.