A Boost for MDR-TB Treatment 

Research drives global counterattack on a leading killer

By JAKE MILLER Research
Tuberculosis pathological sample under microscope
Image: iStock

Every year, multidrug-resistant tuberculosis sickens more than half a million people and kills more than 200,000 around the world.

Although drugs are available that can treat and cure MDR-TB, currently only about 10 percent of people with MDR-TB get treatment that cures them and prevents further transmission of the infectious airborne disease. But in the glow of a special United Nations general assembly meeting on tuberculosis in September, endTB, a global research project that is improving treatment regimens for patients with MDR-TB, received a boost when Unitaid announced that it is intensifying its commitment to fighting TB with a $21 million investment in the project.

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“This landmark extension ensures that people around the world who suffer from multidrug-resistant TB will have a chance to get an all-oral, shortened regimen, which would be prescribed based on the best possible evidence,” said Carole Mitnick, associate professor of global health and social medicine at Harvard Medical School, senior researcher at Partners In Health and co-principal investigator of endTB’s clinical trials.

The extended endTB project works to identify regimens that can be confidently and easily delivered to 100 percent of affected patients, Mitnick said. The ultimate goal of the project is to provide countries and funding agencies, such as the Global Fund, with effective regimens that can be introduced on a massive scale to tackle MDR-TB.

Led by PIH, in partnership with Médecins Sans Frontières, Interactive Research & Development, HMS, the Institute of Tropical Medicine (Antwerp), and Epicentre, endTB has been piloting two new medicines, bedaquiline and delamanid, in 17 countries. The pilot program aims to make treatment for MDR-TB shorter, simpler, more effective, and with fewer side effects.

A physician examines a TB patient.
Patients with MDR-TB currently have to endure a painful two-year treatment which can cause psychosis and hearing loss. Thanks to a new treatment regimen that is simpler, shorter and less toxic, patients are able to get cured more quickly. Video: Unitaid

The endTB project’s original term was 2015-2019 and its budget $60 million. With the extension it will run through the end of 2022, with Unitaid support of up to $81 million.

Long-used treatments for MDR-TB can take up to two years, succeed in only about half the cases, and can cause major side effects such as hearing loss and psychosis.

EndTB’s innovative treatment regimens have the potential to bring about significant public health gains, the researchers said. According to project estimates, the new treatments could cure 119,000 more patients, save 56,000 more lives and avert 239,000 drug-resistant infections over the next eight years.

On the eve of announcing the extension for endTB, Paul Farmer, Kolokotrones University Professor at Harvard and co-founder and chief strategist of PIH, and Lelio Marmora, executive director of Unitaid, published a commentary in STAT calling for an aggressive, unified effort from industry, academic institutions, international funders and nonprofit organizations to fund the clinical trials that will produce the tools needed to prevent and treat TB.

“The disease is relentless and cruel, and lately it has been winning,” they wrote. “But it doesn’t stand a chance if the world comes together to fight back.”

This story is adapted from a Unitaid news release.