We have an implementation problem
After to COVID-19, tuberculosis is the second most common fatal infectious disease in the world. In recent decades, the control of tuberculosis has been made more difficult by the emergence of multidrug-resistant strains of tuberculosis bacteria. Following the development of new drugs, the prognosis for patients suffering from multidrug-resistant tuberculosis has improved considerably. As a result, the World Health Organization (WHO) published new guidelines in autumn 2022 to treat multidrug-resistant tuberculosis with more effective drugs over a shorter period of time. New regimens require only 6 months of therapy, instead of 18 months previously. The new regimen only includes tablets and is free of injections.
One year later, the research network TBNET has now checked in which countries of the WHO European Region the new combination therapy is available and where laboratories can test the susceptibility of tuberculosis bacteria to the 4 drugs of the new combination treatment. The results are shocking. Although the drugs are on the WHO's list of essential drugs and treatment success with the new therapy is 30% better than with the old therapy, the new therapy is only available in half of the countries in the WHO Euro Region. The situation is even worse when it comes to susceptibility testing. Here, just 14% of countries are able to test the sensitivity of bacteria to the drugs used in combination therapy.
"We don't have a research and development problem," says Professor Christoph Lange, Medical Director at the Research Center Borstel and co-coordinator of the study, "but an implementation problem. Patients are dying because they don't have access to vital medicines." Professor Lange also clarifies: "The lack of capacity for susceptibility testing of tuberculosis bacteria to the new combination treatment is a disaster. If everyone receives the same treatment because you don't know which bacteria are susceptible and which are not, you breed out the resistant strains of bacteria. This is a principle of evolution. This is how the problem of multidrug-resistant tuberculosis arose in many countries of the former Soviet Union in the 1990s”.
“Now we are making the same mistake". Lange says. He and his colleagues at TBNET argue that the development of antibiotic resistance diagnostics must keep pace with the development of new drugs and their use. Innovative methods are being developed at the Research Center Borstel and are being evaluated in high-incidence countries for multidrug-resistant tuberculosis.
Publication: Günther G, Guglielmetti L, Kherabi Y, Duarte R and Lange C for the TBNET. Availability of drugs and resistance testing for BPaLM regimen for rifampicin-resistant tuberculosis in Europe. Clin Microbiol Infect 2024 Clinical Microbiology and Infection, 2024, https://doi.org/10.1016/j.cmi.2024.03.009
Contact
Prof. Dr. med. Dr. h.c. Christoph Lange
DZIF TTU TB (ClinTB)
T +49 4537 / 188-3010 (Sekretariat)
F +49 4537 / 188-6030
clange@fz-borstel.de