John* can’t remember the names of all the medications he takes—there are just too many. In the morning, nurses watch him swallow 10 pills and give him an injection, and in the evening, they stop by with another two tablets. The regimen is tiresome, says John, but he is sick and has no other options. John is a multidrug-resistant tuberculosis (MDR-TB) patient at Kibo’ngoto National TB Hospital in Tanzania, one of few local facilities equipped to handle TB patients that have grown resistant two or more of the four drugs that comprise the standard treatment for TB.
John is only partially through his expected six-month stay at Kibo’ngoto, but even when he returns home, many more months of daily treatment await. John says it’s easy for patients to become depressed and despondent—and give up hope that they will ever get better.
Today, on World Heath Day, it is important to remember that John is just one of the many people suffering from the epidemic of drug resistance, which has created exceptional global health challenges, particularly in the treatment of TB.
TB is an ancient disease and continues to be one of the world’s leading killers, with more than 9 million new cases of TB emerging each year. The current treatment consists of 4 drugs that must be taken for 6 months or longer. The difficulties in adhering to such a regimen have resulted in the emergence of MDR-TB and extensively drug-resistant tuberculosis (XDR-TB).
Without effective treatment, TB is deadly. Treatment for so-called “drug-sensitive” TB is already difficult to administer; almost 2 million die from TB each year. The near half a million annual drug-resistant TB cases are even more complicated and costly to treat and are fatal in a third of cases or more. Treatment of MDR-TB or XDR-TB commonly takes two years or longer, and involves daily injectables for six months. The cost of treating a single case of MDR- or MDR-TB can be literally hundreds to thousands of times that of treating a case of drug-sensitive TB.
New drugs for TB—and other infectious diseases—are desperately needed as part of any global plan to fight infectious diseases. Fortunately, today’s public and private TB drug developers are harnessing the power of scientific innovation and are on the verge of breakthroughs that hold the potential to treat drug-resistant TB, and to improve treatment of drug-sensitive TB, which will, in turn, stem the subsequent development of new TB drug resistance. These new TB treatment regimens have the potential to be better, safer, faster-acting, and more affordable, which will enable the global scale up of MDR-TB treatment. Today, given the complexity and cost of MDR-TB treatment, that is simply not possible.
The global TB drug pipeline has several promising candidates and regimens currently in late stage research.
The TB Alliance is working with the help of the United States Agency for International Development (USAID) to improve the treatment of drug-resistant TB and shorten and simplify the treatment of drug-sensitive TB. These initiatives include:
- REMOX TB –A Phase III study evaluating whether substituting moxifloxacin for one of the existing drugs in the current TB regimen could reduce treatment time by two months without compromising efficacy.
- TMC207 – In partnership with Johnson & Johnson/Tibotec, the TB Alliance is developing TMC207, a Phase II compound in parallel development for use against drug-sensitive and drug-resistant TB.
- NC001 –The TB Alliance launched the first clinical trial of a novel TB treatment regimen containing multiple new TB drug candidates. This combination, which includes PA-824, moxifloxacin, and the established TB treatment pyrazinamide, has the potential to reduce the duration of treatment for both drug-sensitive and drug-resistant TB to 4 months or shorter, as well to tremendously reduce the cost of MDR-TB treatment.
*Patient’s name has been changed to protect his privacy