Vital work continues to identify shorter MDR-TB treatment regimens

Reposted from Vital Strategies.

The global battle against TB and MDR-TB is happening on a number of fronts, from efforts to increase access to vaccinations, to the development of faster diagnostic tests that are effective in the resource-constrained environments typical in many high-burden countries, to the launch of new drug treatments. For some time now, the latter has been a source of hope and frustration, even as increasing antimicrobial resistance and the rise in MDR-TB have brought further urgency to the need for progress.  In the absence of new medicines, TB experts have also been examining whether existing medicines could be used in new ways to deliver results.

Rates of MDR-TB increase when patients aren’t diagnosed and treated correctly, and when they don’t complete their treatment regimen, so it’s essential to ensure that patients undertake and complete the most effective treatment regimen for their needs. Currently, these regimens can last up to 24 months and involve frequent, painful injections. This puts a significant burden on the health systems tasked with administering treatment, as well as the patients themselves. Shorter regimens may make completion more likely, so represent an important potential tool in the global battle against MDR-TB.

This week, it was announced that the first patients have been enrolled in Stage 2 of the STREAM clinical trial. The trial is administered by the International Union Against Tuberculosis and Lung Disease and Vital Strategies and has been designed to evaluate simpler and shorter treatment regimens for MDR-TB. The first patients for this new Phase III trial have been enrolled in Mongolia, but eventually STEAM Stage 2 will include at least 10 countries across Africa and Asia with a high burden of MDR-TB.

The trial includes bedaquiline – an existing TB medicine produced by Janssen Therapeutics, a Division of Janssen Products, LP, one of the Janssen Pharmaceutical Companies of Johnson & Johnson – and aims to evaluate an all-oral (injection-free) regimen of six and nine months’ duration.

This study could mark an important turning point in the fight against drug-resistant TB. Data suggest that that less than half of MDR-TB patients are treated successfully. In 2014, 480,000 people were diagnosed with MDR-TB and that year 190,000 people died from this strain of the disease, which is resistant to at least two of the standard four-drug anti-TB drug regimen.

Progress is needed on all fronts of the fight against TB and MDR-TB. We hope the STREAM trials can help to deliver some of the answers.