The World TB Report by the World Health Organisation (WHO) estimated that around 10.4 million people suffer from tuberculosis (TB), making it one of the world’s most fatal infectious diseases.

Of these, 580,000 cases were drug-resistant, killing almost around two million people with more than 95% of the deaths occurring in low- and middle-income countries.

A breakthrough in tuberculosis treatment

A significant moment in the history of TB was seen on 12 May 2016, where the World Health Organisation (WHO) in Geneva announced a new shortened treatment regimen to treat multi-drug resistant tuberculosis (MDR-TB) patients. The duration of this treatment is nine months, which is significantly lower compared to the currently followed 24-month treatment standard used worldwide.

A Damien Foundation study, carrying out the work of Dr. Armand Van Deun, came up with the “Bangladesh Regimen”. This nine-month treatment regimen was used to treat 515 patients from 2005 – 2011. It was hugely successful, with 84.5% cure rate when compared with the 24-month conventional treatment of around 50%.

This declaration is in response to the need to develop treatment outcomes for MDR-TB – a growing public health emergency. It is estimated that there are several patients with uncomplicated MDR-TB in ten different countries. Annually, it is estimated that 480,000 people contract MDR-TB – and this number keeps rising.

Ongoing trial of the new treatment regimen

The STREAM Trial is conducting studies to determine whether the nine-month treatment regimen that demonstrated cure rates exceeding 80% during the pilot programme done in Bangladesh could achieve similar success in other settings. Ethiopia, Mongolia, South Africa and Vietnam participated in Stage One of the trial consisting of 424 patients.

The STREAM research team started Stage Two of the trial on March 2016, which was approved by US Federal Drug Administration (FDA) and the European Medicines Agency (EMA).

In Stage Two, which has 1,155 patients, the randomisation includes two additional regimens, which will then be compared to the Stage One study’s nine-month regimen. The WHO control regimen is also continued in Stage Two. The two new regimens include a recently licensed drug called bedaquiline (created by Janssen Pharmaceuticals).

The first of the new regimens is completely oral in which the injectable medicine that was used in the Stage One regimen – known as kanamycin – is substituted with bedaquiline in Stage Two of the study. The second of the new regimen only be of six months in duration, in which kanamycin will be given for only two months.

The results of Stage 2 of STREAM research are expected to be released on 2021.

To conclude, the persistent efforts of Armand Van Deun and his colleagues from the Damien Foundation and The Union lead to the hope of a shorter and effective regimen for MDR-TB. This seems like a boon to hundreds and thousands of people who finally can combat this disease, which is worse than most malignancies and whose treatment was long and had adverse toxic effects. MIMS

Read more:
Despite new treatment for TB, WHO says efforts to combat disease are sorely lacking
Breaking down the Global Burden of Disease report
WHO: Nine out of ten people globally are breathing polluted air