Trial aims to expand access to better and shorter treatments for drug-resistant forms of TB.
Contact: Jeff Marvin, Media Relations Manager
TBILISI, GEORGIA (March 6, 2017)—Médecins Sans Frontières (MSF), Partners In Health (PIH) and other leading medical organizations have launched a major clinical trial which seeks to revolutionize treatment for the toughest strains of tuberculosis (TB), the world’s leading infectious disease killer. The first patient started treatment in Georgia last week.
The trial is part of a UNITAID-funded transformative project called endTB, which aims to speed up and expand access to better and shorter treatments for drug-resistant forms of TB. The four-year $60 million project, being implemented by PIH, MSF and Interactive Research and Development (IRD), targets 15 countries across three continents.
Following decades of neglect, TB has overtaken HIV as the deadliest infectious disease, killing 1.8 million worldwide last year. Aggravating the problem are the more complicated strains of the disease, which withstand treatments because of antibiotic resistance to the main drugs used in TB treatment. These types of TB are known as ‘multidrug-resistant TB’ (MDR-TB) and worse, ‘extensively drug-resistant TB’ (XDR-TB). The world is losing ground to these resistant forms. Conservative estimates from the World Health Organization (WHO) keep climbing and now place the number of yearly new cases at more than half a million.
Because these strains are just as contagious as normal TB but much more difficult to treat, they represent a significant public health crisis in many countries. MDR-TB and XDR-TB have often been referred to as “Ebola with wings” because the present-day medical treatment for these forms of TB have about the same cure rate as Ebola and the disease is spread from person to person through the air.
Current treatments for MDR-TB are long (up to 24 months), ineffective (only 50% succeed) and often cause terrible side effects, including acute psychosis and permanent deafness. All the while, patients endure months of painful, daily injections and ingest up to 14,000 pills. Moreover, the costliness, difficulty and length of current treatments make them hard to implement in many high-burden countries.
To address the problem, this phase III clinical trial uses the first TB drugs developed in almost 50 years—bedaquiline and delamanid—to find radically shorter (9 months), injection-free, more tolerable treatments for MDR-TB. (The new drugs will be combined into experimental new treatments with other oral TB drugs such as clofazimine, linezolid, fluoroquinolones and pyrazinamide.)
Today only about 10% of MDR-TB sufferers worldwide can hope to access successful treatment, and less than 2% can access bedaquiline or delamanid. The clinical trial will expand the evidence base for using bedaquiline and delamanid, particularly as part of simpler and better treatments that would be easier to implement in resource-poor countries with significant TB burdens. Evidence of success of these regimens, coupled with support for their implementation, would dramatically expand access to successful treatment.
The endTB project is expected to enroll an estimated 2600 MDR-TB patients on treatment with the new TB drugs and 750 patients will take part in a clinical trial across six countries: Georgia, Kazakhstan, Kyrgyzstan, Lesotho, Peru and South Africa. These are all countries with significant TB burdens, where endTB partners support local MDR-TB treatment activities.
“This is the most exciting prospect for people with MDR-TB since PIH first demonstrated the feasibility of treating the disease in resource-poor settings," said Dr. Carole Mitnick, co-principal investigator of the endTB clinical trial for Partners In Health and an associate professor for Harvard Medical School. "If established as successful, shorter, injection-free regimens that are suitable for a diverse and large proportion of MDR-TB patients would be transformative."
“Together, PIH and MSF have expanded structures, resources, treatment, evidence, and ambitions for this and other complex diseases affecting poor people," Mitnick said. "The endTB clinical trial is a natural extension of this decades-long collaboration between two organizations that place priority on expanding access to proven, high-quality interventions among patients who need them, regardless of economic or socio-political situations in which they live.”
The trial, for which MSF is sponsor, benefits from the expertise of Harvard Medical School, Epicentre and the Institute of Tropical Medicine Antwerp. The clinical trial team also works closely with Ministries of Health and National Tuberculosis Programs (NTP) in each country, as well as the WHO and ethics review boards.
This is the second TB clinical trial sponsored by MSF. The first, TB PRACTECAL, launched in Uzbekistan in January 2017.
Partners In Health is an international medical organization that helps build and sustain public health systems in poor and underserved communities around the world. Launched in Haiti in 1987, PIH today reaches 7 million people around the world and employs 18,000 people, including 15,000 local community health workers. PIH uses a community-based approach to care that has resulted in some of the highest cure rates and lowest treatment default rates ever recorded for TB and HIV. It is running the endTB clinical trial in Peru, Lesotho, and Kazakhstan, and is bringing new TB medications to five countries. Learn more about our work at www.pih.org. Support our efforts at https://donate.pih.org/give-today.
Together we save lives and spread hope in the poorest places on Earth.