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Hope for drug-resistant TB?

Tuberculosis (TB) or, more specifically, drug-resistant tuberculosis (MDR-TB), is shaping up to be one of India’s foremost health concerns in the future.

Photo credit: Prof Madhukar Pai, MD, PhD Canada Research Chair in Epidemiology & Global Health Director, McGill Global Health Programs Associate Director, McGill International TB Centre
X-rays of a tuberculosis patient in India

Studies claim that India accounts for 27 percent of the world’s 10.4 million new TB cases and 29 percent of the 1.8 million deaths globally. India also accounts for sixteen percent of the estimated 480,000 new annual cases of multidrug-resistant tuberculosis (MDR-TB).

TB is becoming increasingly difficult to treat. There is potential that, in the future, MDR-TB strains spread to become the most common form of the disease, negating all first-line treatments. Such a scenario could place a huge burden on economies, especially those of low-income and middle-income countries (LMICs), due to the fact that second-line treatments are often more expensive.

Bedaquiline, currently hailed as a “miracle cure” in the treatment of MDR-TB, is only recently seeing more widespread use in India. Despite it being new to the market there are already reports from hospitals of bedaquiline-resistant strains appearing. Such strains, if widespread, could become all but untreatable. Fortunately, there could be hope in the form of a new development.

The US Food and Drug Administration’s (FDA) has issued approval of the TB Alliance’s treatment for MDR-TB as part of a three-drug combination regimen called BPaL. The newly developed drug pretomanid will be used in combination with linezolid and Johnson & Johnson’s bedaquiline. The hopes of the combination is to use several medications so that at least one will be effective, therefore circumventing the potential that TB strains are resistant to at least one medication.

While being a hopeful new development, it is worth noting there may be little point in remaining hopeful of a quick fix. Bedaquiline, as part of the treatment, is still in limited use in India, which may considerably delay uptake of the new treatment. 

However, specific details of the approval may present a light at the end of the tunnel. The TB Alliance granted a license to Mylan NV in April to manufacture and sell pretomanid as part of certain regimens in high-income markets. LMICs have been granted a non-exclusive license, opening the door for domestic production within India — a move that could be a considerable boon to the fight against TB.

New developments are clearly needed in the global fight against TB. However, for progress to be made these developments must be made accessible to more than just wealthy nations.

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