A promise for shorter and less expensive treatments
According to the findings presented at the virtual Conference on Retroviruses and Opportunistic Infections last month, favourable outcomes were sustained 24 months after completion of treatment even among those with HIV.
Success rate of 90 per cent
Howell adds that the current treatment of multi-drug TB is very long — about 20 months, has side effects such as daily nausea, psychosis, with a quarter getting hearing loss, in settings that still use injectables. “There is also the high pill burden of more than 14,000 tablets [that] does not work well, curing less than half of people,” she explains.
Howell says that in the trial involving 109 participants, 98 had favourable outcomes, representing a success rate of 90 per cent at six months after treatment.
More clinical trials
The trial began enrolling participants in 2015 and the study’s results were published in the New England Journal of Medicine last year (5 March 2020) but the two-year follow-up occurred in 2020.
Howell adds that clinical trials are under way in other countries including Georgia, Moldova, and Russia, with operational research programmes in Ghana, Laos, South Africa, Tajikistan and Ukraine. Many more are expected to enroll patients this year including in Sub-Saharan Africa.
She adds, after the end of a study, one participant relapsed 15 months after treatment, one patient who was participating in the clinical research trial could not be located for a follow-up while the rest sustained favourable outcomes 24-months post completion of treatment. Follow-up is the monitoring of a person’s health over time after treatment.
The study shows that treatment for severe forms of TB can be shortened. It also reduces the pill burden to fewer than 750 pills over the treatment course compared with the 14,000 or more for a patient on alternative treatments. This is particularly promising for Sub-Saharan Africa because of the long and less effective treatment currently available for drug resistant TB.
The 90 per cent success rate reported in the clinical trial means that patients could be able to return to their lives sooner and health systems could be less burdened by long, expensive, and ineffective treatments.
“TB is a lethal pandemic and new, effective treatments are urgently needed. This represents a new treatment option for the deadliest forms of a leading infectious killer,” Howell explains.
Reducing treatment costs
Paul Yonga, consultant in infectious diseases and tropical medicine, and consultant clinical epidemiologist at Kenya-based CA Medlynks Clinic, says that treatment success was achieved in a short period with the oral therapy as opposed to the seven-drug regimen currently used by many countries in Sub-Saharan Africa where treatment lasts anywhere between 18 months and two years.
“It is also encouraging that less than one per cent of participants in the trial discontinued medication, either due to side effects or loss to follow-up,” he tells SciDev.Net.
This could significantly reduce the cost, both to African governments in treating multidrug-resistant TB to the patient with regard to shortened time periods of treatment and reducing time that would have been spent on health facility visits for the injectable drug.
This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.