Limits...
The need to accelerate access to new drugs for multidrug-resistant tuberculosis.

Cox HS, Furin JJ, Mitnick CD, Daniels C, Cox V, Goemaere E - Bull. World Health Organ. (2015)

Bottom Line: Barely 20% of these people currently receive recommended treatment and only about 10% are successfully treated.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Microbiology and the Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory 7925, South Africa .

ABSTRACT
Approximately half a million people are thought to develop multidrug-resistant tuberculosis annually. Barely 20% of these people currently receive recommended treatment and only about 10% are successfully treated. Poor access to treatment is probably driving the current epidemic, via ongoing transmission. Treatment scale-up is hampered by current treatment regimens, which are lengthy, expensive, poorly tolerated and difficult to administer in the settings where most patients reside. Although new drugs provide an opportunity to improve treatment regimens, current and planned clinical trials hold little promise for developing regimens that will facilitate prompt treatment scale-up. In this article we argue that clinical trials, while necessary, should be complemented by timely, large-scale, operational research that will provide programmatic data on the use of new drugs and regimens while simultaneously improving access to life-saving treatment. Perceived risks - such as the rapid development of resistance to new drugs - need to be balanced against the high levels of mortality and transmission that will otherwise persist. Doubling access to treatment and increasing treatment success could save approximately a million lives over the next decade.

No MeSH data available.


Related in: MedlinePlus

Estimated global number of people with multidrug-resistant tuberculosis, 2015–2024
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Figure 1: Estimated global number of people with multidrug-resistant tuberculosis, 2015–2024

Mentions: Treatment as prevention has the dual aims of reducing mortality and interrupting disease transmission. The benefits and risks of accelerated access to new drugs – potentially leading to a greater proportion of patients receiving treatment and a greater treatment success – can be compared with those achieved through a more restricted and gradual introduction. For example, if the incidence of MDR tuberculosis stays the same for another decade, 4.8 million patients will develop MDR tuberculosis.1 Doubling access to treatment from the current level of 20% of patients, and increasing treatment success to 80% would result in cure for more than a million additional patients over the next decade (Fig. 1). Given 80% treatment success, tripling access could save 1.8 million lives over the same period. The aim should not be to limit access to new drugs but to facilitate access in a manner that provides the greatest benefit while minimizing risk.


The need to accelerate access to new drugs for multidrug-resistant tuberculosis.

Cox HS, Furin JJ, Mitnick CD, Daniels C, Cox V, Goemaere E - Bull. World Health Organ. (2015)

Estimated global number of people with multidrug-resistant tuberculosis, 2015–2024
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4490806&req=5

Figure 1: Estimated global number of people with multidrug-resistant tuberculosis, 2015–2024
Mentions: Treatment as prevention has the dual aims of reducing mortality and interrupting disease transmission. The benefits and risks of accelerated access to new drugs – potentially leading to a greater proportion of patients receiving treatment and a greater treatment success – can be compared with those achieved through a more restricted and gradual introduction. For example, if the incidence of MDR tuberculosis stays the same for another decade, 4.8 million patients will develop MDR tuberculosis.1 Doubling access to treatment from the current level of 20% of patients, and increasing treatment success to 80% would result in cure for more than a million additional patients over the next decade (Fig. 1). Given 80% treatment success, tripling access could save 1.8 million lives over the same period. The aim should not be to limit access to new drugs but to facilitate access in a manner that provides the greatest benefit while minimizing risk.

Bottom Line: Barely 20% of these people currently receive recommended treatment and only about 10% are successfully treated.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Microbiology and the Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory 7925, South Africa .

ABSTRACT
Approximately half a million people are thought to develop multidrug-resistant tuberculosis annually. Barely 20% of these people currently receive recommended treatment and only about 10% are successfully treated. Poor access to treatment is probably driving the current epidemic, via ongoing transmission. Treatment scale-up is hampered by current treatment regimens, which are lengthy, expensive, poorly tolerated and difficult to administer in the settings where most patients reside. Although new drugs provide an opportunity to improve treatment regimens, current and planned clinical trials hold little promise for developing regimens that will facilitate prompt treatment scale-up. In this article we argue that clinical trials, while necessary, should be complemented by timely, large-scale, operational research that will provide programmatic data on the use of new drugs and regimens while simultaneously improving access to life-saving treatment. Perceived risks - such as the rapid development of resistance to new drugs - need to be balanced against the high levels of mortality and transmission that will otherwise persist. Doubling access to treatment and increasing treatment success could save approximately a million lives over the next decade.

No MeSH data available.


Related in: MedlinePlus