Much Shorter Regimen for Drug-Resistant TB Shows Better Results
Teenage TB patients in a hospital in Vietnam.

The days of people with rifampicin-resistant tuberculosis (TB) taking up to 20 pills daily, interspersed with injections,  for up to 20 months might be over.

This follows the release on Wednesday of the preliminary results of a trial of a six-month oral treatment that researchers found to be substantially more effective than the current standard of care.

The TB-Practecal trial tested a six-month regimen of bedaquiline, pretomanid, linezolid and moxifloxacin (BPaLM), against the locally accepted standard of care. 

The trial involved 552 patients at seven trial sites across Belarus, South Africa and Uzbekistan.

“Some  89% of patients in the BPaLM group were cured, compared to 52% in the standard of care group. Tragically four patients died from TB or treatment side effects in the control group,” according to trial leaders Medecins Sans Frontieres (MSF), who revealed the findings at the 52nd Union World Conference on Lung Health.

“Patients were telling us how hard it was to adhere to treatment, but little progress was being made to find kinder treatments because diseases most prevalent in low- and middle-income countries don’t attract investment. So we were compelled to pursue new treatment options ourselves. These results will give patients, their families and healthcare workers worldwide, hope for the future of DR-TB treatment,” Dr Bern-Thomas Nyang’wa, MSF Medical Director and Chief Investigator of the trial, told the Union press conference on Wednesday.

Around 500,000 people develop rifampicin resistant tuberculosis (RR-TB) annually, and this intervention could save lives and substantially improve the quality of life of people with rifampicin-resistant TB.

Genome sequencing

Meanwhile, the conference also heard from researchers who used genome sequencing to effectively predict strains of tuberculosis susceptible to antibiotics that were likely to develop drug resistance.

The researchers looked at drug-susceptible bacteria and aimed to identify mutations that would increase the probability of a bacteria becoming resistant in the future. The mutations confer “pre-resistance”. Monitoring these mutations could prevent the amplification of drug resistance in the population by targeting those bacteria more likely to become resistant. 

We found that isoniazid mono-resistance backgrounds have a much higher risk of acquiring further rifampicin resistance than susceptible backgrounds,” said lead author Arturo Torres Ortiz, a PHD Student at  Imperial College in the UK.

“Rapid molecular tests usually focus on rifampicin resistance, which means that isoniazid mono-resistance is missed. This results in amplification into multi-drug resistance. We thus recommend that rapid molecular tests also identify regions associated to isoniazid resistance-conferring mutations.”

Image Credits:

Combat the infodemic in health information and support health policy reporting from the global South. Our growing network of journalists in Africa, Asia, Geneva and New York connect the dots between regional realities and the big global debates, with evidence-based, open access news and analysis. To make a personal or organisational contribution click here on PayPal.