New Tuberculosis Drug Regimen Helps Patients with Extensive Resistance

Valérie Batselaere/MSF
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Grozny, Russia—Doctors Without Borders/Médecins Sans Frontières (MSF) says a new combination of drugs created to treat extensive drug resistant tuberculosis (XDR-TB) is having a significant impact on a group of patients who are in the midst of a two-year treatment to cure their disease.

In 2013, an MSF team in Grozny noticed a growing number of patients with multi-drug resistant tuberculosis (MDR-TB) were not responding to treatment and appeared to be resistant to second-line drugs. At this time, there was no medication in Russia to help them.

Multidrug-resistant TB (MDR-TB) is resistant to at least two of the best anti-TB drugs, isoniazid and rifampicin. These drugs are considered first-line and are used to treat all persons with TB. XDR-TB is caused by strains of MDR-TB that are also resistant to second-line drugs, including at least one from the class of fluroquinolones, and at least one of three injectable second-line drugs.

MSF made a proposal to the Ministry of Health (MoH) to tackle XDR-TB in a new way. In April 2014, MSF began treating patients suffering from XDR-TB with a combination of second-line TB drugs and a new drug called bedaquiline. Four additional re-purposed drugs recognized by the World Health Organization are also being used, including clofazimine (commonly used for leprosy), linezolid, amoxicillin/clavulanic acid, and imipenem/cilastatin (commonly used for other infections). This combination of drugs has never been used in Russia before.

To date, MSF has initiated 51 patients on the new drug regimen that contains bedaquiline. Over the course of the two-year treatment each patient will receive a different combination of the drugs according to the severity of their illness. Twenty-eight patients who require imipenem are being treated in hospital as they require a surgical procedure to insert a catheter to administrate the drug.

MSF is now in the process of handing over its drug-sensitive and multi-drug resistant patients back to the MoH in order to focus its efforts on these XDR-TB patients. MSF doctor Animesh Sinha says the first outcome of people being treated on the new regimen is very promising: “With the new regimen we have seen excellent results that would have been unthinkable before.”

MSF has also started treating patients suffering from both TB and diabetes, as people who suffer from diabetes can be more prone to contracting TB. A total of 12 patients are currently enrolled in that program.