WHO recommends shorter regimen, new diagnostic test for MDR-TB

WHO has announced that it is now recommending a shorter and less expensive treatment regimen for multidrug-resistant tuberculosis, as well as a novel rapid diagnostic test that detects second-line drug resistance, according to a press release.

“This is a critical step forward in tackling the MDR-TB public health crisis,” Mario Raviglione, MD, director of the Global TB Programme at WHO, said in the release. “The new WHO recommendations offer hope to hundreds of thousands of MDR-TB patients who can now benefit from a test that quickly identifies eligibility for the shorter regimen, and then complete treatment in half the time and at nearly half the cost.”

Mario Raviglione

Abbreviated treatment improves outcomes

The shorter treatment, priced at less than $1,000 per patient, includes a 4- to 6-month regimen containing kanamycin, moxifloxacin, prothionamide, clofazimine, pyrazinamide, high-dose isoniazid and ethambutol, followed by a 5-month regimen of moxifloxacin, clofazimine, pyrazinamide and ethambutol. It is recommended for patients with uncomplicated MDR-TB whose disease is not resistant to fluoroquinolones and injectables, and patients who have not received second-line drugs. WHO based its recommendation on preliminary studies involving 1,200 patients with uncomplicated MDR-TB in 10 countries.

Compared with the conventional 18- to 24-month treatment duration, which is associated with a 50% cure rate, WHO anticipates that the shorter treatment duration will increase adherence, thereby improving patient outcomes and reducing MDR-TB mortality rates.

Rapid diagnostic test detects second-line drug resistance

To determine whether patients are resistant to second-line drugs and eligible to receive the shorter regimen, WHO has recommended the use of the DNA-based diagnostic test MTBDRsl (Hain Lifescience). The test can produce results in 24 to 48 hours compared with the 3-month duration currently required to diagnose patients with MDR-TB, the release said. The rapid results will allow physicians to more quickly assign patients to appropriate treatments. According to WHO, less than 20% of the 480,000 patients with MDR-TB currently receive proper treatment.

Karin Weyer

“We hope that the faster diagnosis and shorter treatment will accelerate the much-needed global MDR-TB response,” Karin Weyer, DSc, coordinator of laboratories, diagnostics and drug resistance for WHO’s Global TB Program, said in the release. “Anticipated cost-savings from the rollout of this regimen could be reinvested in MDR-TB services to enable more patients to be tested and retained on treatment.”

Reference:

Aung KJM, et al. Int J Tuberc Lung Dis. 2016;doi:10.5588/ijtld.14.0100.

Disclosures: Raviglione and Weyer report no relevant financial disclosures.