Adoption of New TB Drugs

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TB is an airborne infection that, if untreated, causes coughing blood, wasting away, and an inevitable slow death. In 2012, an estimated 8.6 million people developed TB, and 1.3 million people died from it. TB continues to cause a huge amount of sickness and death since it evolves into drug-resistant TB (DR-TB) resulting in a lower probability of cure.

  • According to WHO estimates, in 2012, there were 450,000 new cases of MDR-TB among detected TB cases and nearly half as many remained undetected
  • Pakistan has the fifth highest number of MDR-TB cases in the world
  • MDR-TB is 3.5% among new TB cases and 32% among previously treated cases

Some challenges for treatment of DR-TB are:

  • Low cure rates due to poor activity of second line drugs to treat MDR-TB
  • Treatment requires 4 to 5 “effective” second line drugs and most of these drugs were invented decades ago. These drugs fell out of use due to weak sterilising activity or severe side effects 

    After 50 years, there’s a ray of hope, as two new drugs (i.e. bedaquiline & delaminid) have been developed and approved by the Food & Drug Administration and the European Medicines Agency. Due to lack of sufficient data and evidence on safety and efficacy, the governments are reluctant to adopt these drugs in their national TB programmes.

    Up till October 2016, only 5,700 patients had received bedaquiline globally, and only 405 had access to delaminid. World Health Organization (WHO) estimates that 580,000 people were eligible for MDR-TB treatment in 2015.

    International stakeholders such as the WHO Task Force for New Drug Policy Development and Stop TB Partnership are for the adoption of these two drugs in Pakistan. Moreover, the Infectious Diseases Committee in Pakistan also realises the benefits and is for the use of these drugs. However, the National TB Control Program, Pakistan is still not committed since it is assessing the costs incurred, logistics of procuring and disbursing these drugs and the risks of administering these drugs.

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