The World Health Organization (WHO) released today the 2022 edition of its Global Tuberculosis (TB) Report, featuring data on the TB response and trends in 215 countries and areas. Among the alarming trends from 2021, there is an increase in the estimated incidence of TB for the first time in two decades, including for the more difficult to treat form of this disease, drug-resistant TB (DR-TB). Lower TB detection rates than in 2019 are also reported, meaning more undiagnosed cases, increased deaths, and transmission. Still only one in three people with DR-TB is getting treatment for the disease and the treatment success rate for DR-TB, at 60% globally, remains low.
It is therefore critical that all existing tools are utilised to tackle TB and that newer tools for DR-TB are made available and accessible. Especially because a ground-breaking TB clinical trial, TB-PRACTECAL, concluded in 2021, showed that newer and shorter all-oral 6-month DR-TB treatment regimens are safer and more effective at treating DR-TB than the previously accepted standards of care. In response, in May 2022, WHO recommended two new regimens for people with DR-TB, in place of existing ones: the 6-month BPaLM regimen evaluated in MSF’s TB PRACTECAL clinical trial, comprised of bedaquiline, pretomanid, linezolid and moxifloxacin with an 89% success rate; and the BPaL regimen, evaluated in the ZeNix study with a success rate of 84% to 93% depending on the dosage of linezolid.1
The new BPaLM regimen could have a huge positive impact on the quality of care for many of the 500,000 people who fall sick each year with DR-TB, but the current lowest global price for a six-month treatment course of BPaLM is still too high at around US$700 (12 536,05), which could slow uptake in high-TB-burden countries. Given that the two most expensive drugs in the BPaLM regimen, pretomanid and bedaquiline – which were both developed with public funding – could be produced and sold at a profit for significantly less than their current prices, MSF continues to demand that the price of a complete DR-TB treatment course be no more than $500 (R8 954,74) per person.
Dr Hannah Spencer, TB/HIV/Hepatitis Advisor, MSF South African Medical Unit:
“DR-TB is curable, but alarmingly, cases are on the rise around the world for the first time in years, so it’s urgent that shorter, safer and more effective treatments are scaled up now to save lives.
“MSF teams support the scale up of shorter DR-TB regimens in collaboration with health ministries in places where we work, but it remains devastating for us to see so many people continue to struggle on the longer, older DR-TB treatments. National TB treatment programs and donors should make it their first order of business to make better treatments available. And prices must come down, so that a complete DR-TB treatment course is priced no higher than $500 (R8 954,74) per person. Everyone with DR-TB should have access to ground-breaking newer treatments.
“In light of these grim statistics, there is an urgent need for all WHO-recommended tools to be optimally used against TB, and for an increase in investment to develop new medical tools to treat, diagnose and prevent TB.”
Notes to the Editor:
MSF is one of the largest non-governmental providers of TB treatment in the world. In 2021, 17,221 people in MSF’s care were started on TB treatment, including 2,309 with drug-resistant TB.
1 MSF is mindful of high level of resistance to fluoroquinolones in some regions (e.g., India) and that BPaLM (specifically the “M” = moxifloxacin belonging to the fluoroquinolone drug class) may not always be appropriate, which is why individualisedregimens containing the other new drug delamanid combined with bedaquiline, linezolid and clofazimine and other DR-TB drugs are important in such contexts and are being currently tested in the MSF sponsored endTB trial. In addition, alternative regimens are being tested in the endTB-Q clinical trial and were tested in the TB-PRACTECAL trial like BPaLC (with clofazimine on top of BPaL).