Tuberculosis

DR-TB Drugs Under the Microscope, 5th Edition (Abridged)

Despite some positive developments, access to safe and effective treatment for drug-resistant tuberculosis (TB) remains poor.

Although TB is the number-one infectious disease killer and one of the top ten causes of mortality worldwide, the global response to TB remains off track. The TB epidemic is exacerbated by the rise of drug-resistant TB (DR-TB), flagged by World Health Organization (WHO) as a global emergency in 2014 and again in 2017. An estimated 558,000 people fell ill with drug-resistant forms of TB in 2017 – but only 25% of them were started on treatment.

The interim 2020 targets set by the WHO End TB Strategy – to reduce new TB infections by 20%, reduce TB deaths by 35%, and eliminate catastrophic costs of treatment for families – won’t be reached unless there is a dramatic increase in the pace of the global TB response. Meeting the global TB goals requires not only broad implementation and effective use of the current tools available to prevent, diagnose and treat TB, but also the development of better clinical tools, from point-of-care rapid diagnostic and drug-resistance tests, to safer, shorter and more effective treatment regimens that are easier to administer.

The 5th edition of “DR-TB Drugs Under the Microscope” chronicles the changing landscape of available treatments for DR-TB, outlines the key barriers to accessing the most effective treatments, and makes recommendations for action that can improve TB care on a global scale.

An Online Supplement to the issue brief includes additional information on drug prices and quality, registration status, and paediatric formulations available to treat children with DR-TB. Company contacts and conditions of offer are also presented.

Additional publications in the DR-TB Drugs Under the Microscope report series are available here.

Learn more about MSF’s work to improve access to lifesaving TB treatment.

antimicrobial resistancedrug-resistant TBtuberculosis moxifloxacinlinezolidbedaquilinedelamanid Union Conference on Lung HealthMedicines Patent PoolStop TB PartnershipTB AllianceThe Global Drug FacilityUNITAIDCiplaJohnson & JohnsonOtsukaPfizer Tuberculosis DRTB Drugs Under the Microscope Issue brief access to medicinesdiagnostic testsgeneric medicinesinnovationpatent poolresearch and development (R&D)voluntary licence
Simbongile Xesha collects her medication from the pharmacy at Town 2 Clinic, Kuyasa, Khayelitsha, South Africa. 2016. Photograph by Sydelle Willow Smith

Despite some positive developments, access to safe and effective treatment for drug-resistant tuberculosis (TB) remains poor.

Report cover for UTM Issue Brief

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The 5th edition of “DR-TB Drugs Under the Microscope” chronicles the changing landscape of available treatments for DR-TB, outlines the key barriers to accessing the most effective treatments, and makes recommendations for action that can improve TB care on a global scale.

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TB UN High-Level Meeting Fact Sheet

At the September TB summit, world leaders must commit to ambitious action to defeat TB

TB is the world’s leading infectious disease killer. Poor political commitment and underfunding of TB research and development (R&D) are fuelling this global health emergency.

World leaders will meet in New York on 26 September 2018 for the first ever UN High-Level Meeting (HLM) on TB. Ahead of the summit, Médecins Sans Frontières (MSF) joins others in calling on governments to make firm commitments to close the deadly gaps in TB testing, treatment and prevention. To save lives, governments must pledge to scale up use of the tools we have to tackle TB today – and commit to developing and delivering faster, safer and simpler tools for tomorrow.

An ancient and deadly disease

Kyaw Thu is 26 years old. 5 months ago, he went to the clinic at Thon because his body temperature was very high but he felt cold at the same time. There, he tested positive for MDR-TB. Every morning, he wakes up at 7am and travels to the MSF clinic for his medications and his injections.
Kyaw Thu, 26, is receiving treatment for multidrug-resistant TB at an MSF clinic in Yangon, Myanmar. His treatment will take two years to complete and consist of 12,000 pills and 168 painful injections. Photograph by Alessandro Penso/MAPS

People continue to lose their lives to TB because they can’t access treatment, or because the treatment they need simply doesn’t exist at all.

  • An estimated 1.6 million people died from TB in 2017. TB is also the leading cause of death among people living with HIV – an estimated 300,000 of whom died due to TB the same year.
     
  • Of the estimated 10 million people who fell ill with TB in 2017, only 6.4 million were diagnosed1, leaving more than 3.5 million people with TB undiagnosed and untreated. Late diagnosis can lead to delayed treatment initiation, poorer treatment outcomes and greater risk of transmitting TB to others.
     
  • Drug-resistant TB (DR-TB) is a growing threat. By 2050, DR-TB could cause up to one-quarter of an estimated 10 million deaths every year due to antimicrobial resistance (AMR).
     
  • Diagnosing DR-TB is difficult. In 2017, only 29% of people with DR-TB are diagnosed; just 25% were started on treatment.
     
  • Standard treatments for DR-TB can take up to two years and can have severe side effects, including deafness and psychosis; they also have low cure rates: 55% for multidrug-resistant (MDR) and 34% for extensively drug-resistant (XDR) TB.
Infographic for TB Summit UNHLM, 2018

Saving lives today

Governments have a responsibility to rapidly scale up the use of improved TB diagnostic, treatment and prevention tools that are already available. A growing body of evidence shows that treatment regimens containing the newer DR-TB drugs bedaquiline and/or delamanid are more beneficial to patients than standard regimens.4,5,6 However, these medicines remained inaccessible to almost 90% of people who were eligible to receive them in 2017. New World Health Organisation (WHO) recommendations released in August 2018 prioritise the use of oral drugs, including bedaquiline.6 Expanding access to safer, more effective, injection-free treatment regimens will improve treatment outcomes and prevent the needless suffering that often results from older treatments.

Research and development for tomorrow

The 2015 “End TB”  goals endorsed by WHO Member States to reduce TB deaths and new infections cannot be met unless improved treatment regimens, fast and simple diagnostics and effective vaccines are developed. Although governments also committed to support and intensify TB R&D, current funding is extremely insufficient. There is an estimated $1.3 billion per year funding gap8.

Governments have a collective responsibility to mobilize the TB research community and to immediately and significantly increase TB R&D funding for affordable new treatments, diagnostics and vaccines. Action is needed to expedite the development and delivery of:

  • Faster, safer and simpler all-oral treatment regimens that are effective to treat children and adults and all forms of TB, and adapted for use in low-resource settings. This requires a healthier drug pipeline that continues to deliver multiple improved treatment regimens.
     
  • TB diagnostic tools suited for use in low-resource settings, including rapid drug resistance tests for all TB drugs to guide individualised, appropriate and effective treatment for people with DR-TB.

Governments have a collective responsibility to create an enabling environment  and support novel collaborative research models that guarantee a better public return on public investment. Action is needed to ensure researchers and developers:

  • Follow agreed-upon target product and treatment regimen profiles that address priority health needs and deliver tools adapted for use in low-resource settings;
     
  • Share research results, including pre-clinical and clinical trial data, as well as molecules, in order to accelerate research and facilitate the development of regimens comprising novel classes of drugs; and
     
  • Commit to equitable access and fair pricing of end products, including by ‘de-linking’ investments in R&D from the expectation of high profits through high prices and sales.
drug-resistant TBtuberculosis Tuberculosis Fact sheet
Kyaw Thu is 26 years old. 5 months ago, he went to the clinic at Thon because his body temperature was very high but he felt cold at the same time. There, he tested positive for MDR-TB. Every morning, he wakes up at 7am and travels to the MSF clinic for his medications and his injections. Photograph by Alessandro Penso

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