Aggressive treatment regimens can successfully treat XDR-TB, MDR-TB

Aggressive treatment regimens successfully can treat nearly half of patients with extensively drug-resistant tuberculosis and can help prevent multi-drug resistant TB from developing into XDR-TB, according to a study conducted in prisons in Tomsk, Russia, and published Monday in the journal Lancet, Reuters reports. XDR-TB is resistant to the two most potent first-line treatments and at least two of the classes of second-line drugs.

For the study, Salmaan Keshavjee of Partners in Health, Brigham and Women's Hospital and Harvard Medical School and colleagues examined 608 patients with MDR-TB between September 2000 and November 2004. Four percent of the patients, or 29 people, had XDR-TB (Fox, Reuters, 8/24). None of the XDR-TB patients and 1% of the MDR-TB patients had HIV (Britt, Bloomberg, 8/25).

Patients received an individually tailored treatment program based on their particular TB strain, including at least five drugs to which their strain was susceptible (BBC News, 8/24). According to the study, the combination treatment of five effective TB drugs and two less effective TB drugs successfully treated 48.3% of the XDR-TB patients and 66.7% of the MDR-TB patients. A study published earlier this month in the New England Journal of Medicine reported similar results in HIV-negative XDR-TB and MDR-TB patients in Peru (Reuters, 8/24). The study was funded by the Bill and Melinda Gates Foundation and the Eli Lilly Foundation (Bloomberg, 8/25).

Keshavjee said the 48.3% treatment success rate among XDR-TB patients is "promising" because XDR-TB "has been touted as untreatable" (Reuters, 8/24). A 2006 study conducted in South Africa found that 52 of 53 XDR-TB patients died within a relatively short time of diagnosis. All of the people with XDR-TB in the South African study were HIV-positive (GlobalHealthReporting.org, 8/7). Keshavjee added that "it may be possible to slow the rise of XDR-TB deaths" and "reduce further transmission" of drug-resistant strains of TB through aggressive management "by ensuring that patients are correctly diagnosed as early as possible and put on appropriate treatment for the correct length of time" (Reuters, 8/24).

Reaction

John Moore-Gillon, spokesperson for the British Lung Foundation, said that the study is "very important" and demonstrates that it is "possible to deal with XDR-TB" but added that it is "very expensive" to implement aggressive drug treatment regimens. According to Moore-Gillon, treatment for XDR-TB is "extremely labor and resource intensive and has to be done within extremely well-structured TB programs." He added that treating XDR-TB costs "much more" than MDR-TB treatment. "The reason we have the problem is inadequate control of TB," Moore-Gillon said (BBC News, 8/24).

Helen Cox and Cheryl McDermid of Medecins Sans Frontieres in an accompanying commentary said that "aggressive treatment [of XDR-TB] is the logical strategy to provide the best chance of [treatment success] while avoiding the creation of additional drug resistance," but added that researchers "should be cautious in [their] hope to attain such success rates in settings with a high prevalence of HIV" (Bloomberg, 8/25).

An abstract of the study is available online.


Kaiser Health NewsThis article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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