Arduous Treatment
TB can be cured, but it’s a long process
Tuberculosis (TB) is curable, but it takes a minimum of six months on a cocktail of various antibiotics. The first-line treatment regimen has remained essentially unchanged for decades and there have been no developments to decrease either the time it takes or the number of medications required. And despite the long time that these medicines have been around, there are still not suitable formulations for children.
Drug resistant TB (DR-TB) is when the TB bacterium is resistant to at least one of the first-line antibiotics. There are an estimated half million cases of DR-TB, but the number is likely higher, because of the difficulties diagnosing it. There is an even more deadly form of DR-TB, known as extensively drug resistant TB (XDR-TB) which occurs when there is additional resistance to second-line drugs. XDR-TB has been found in 58 countries and carries a very poor prognosis for patients, with few drugs available to treat it.
Up to 20 pills a day, with intolerable side effects
Patients with DR-TB must take a daily cocktail of drugs: as many as twenty pills a day, and in the early stages of treatment, a daily painful injection. The side effects of such treatment range from persistent nausea to psychosis and total deafness. Some patients find the side effects too arduous to bear and interrupt or stop treatment altogether. These interruptions in treatment can be dangerous, as they can lead to the patient developing even worse drug-resistance, with even fewer treatment options left.
Challenges of cost and availability
Beyond the medical limitations, the medicines to treat DR-TB present other challenges. A patient’s treatment course for DR-TB can cost almost US$ 9,000 – that’s nearly 475 times more than a $19 treatment course for standard TB. Alarmingly, in recent years, prices for several drugs have actually been increasing as some manufacturers put an end to subsidies that have kept prices low, or have stopped producing the drug altogether, creating a monopoly market.
In addition, dependence on a very small number of manufacturers for quality-assured sources of the medicines can lead to supply problems. This in turn can lead to dangerous treatment interruptions for patients if those manufacturers cease production for any reason. Over the last two years, there have been global shortages in at least two of the important injectable antibiotics which are vital to treat DR-TB.
Better drugs needed
Because of the difficulties surrounding the diagnosis and treatment of DR-TB, less than one percent of the people infected with DR-TB since 2000 had access to appropriate treatment. With small numbers of patients on treatment, there is little incentive for manufacturers to develop newer, better, more effective drugs to treat the disease.
But the development of a new diagnostic test that has the potential to greatly improve detection of DR-TB should help increase demand for treatment. In addition, several new drugs are slated to come to market over the next few years. The role that these new drugs can play to improve and even shorten the treatment regimen for DR-TB is yet to be established, and there remains much to do to ensure secure access to these and other treatments for DR-TB.
Last Updated: July 2011
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