Rapid Communication: Key changes to the treatment of drug-resistant tuberculosis
11 December 2019 | GENEVA – Significant improvements in treatment outcomes and quality of life for patients with drug-resistant tuberculosis (TB) are expected, following key updates to treatment approaches, announced by the World Health Organization (WHO) in a Rapid Communication released today.
Treatment success for multidrug-resistant and rifampicin resistant TB (MDR/RR -TB) (1) is currently low in many countries. This could be increased by improving access to new regimens that are more effective, less toxic and easier to implement for eligible patients. In November 2019, WHO convened a meeting of its Guideline Development Group to update WHO Consolidated Guidelines on the treatment of drug-resistant TB, based on new evidence shared by countries, research and technical partners, and through responses to the public call for data.
The changes suggested by the evidence review are the phasing out of shorter injectable containing regimens and the introduction of a shorter all-oral bedaquiline containing regimen for eligible MDR/RR-TB patients. In addition, in patients with extensively drug resistant (XDR -TB) (2), a shorter regimen with bedaquiline, pretomanid and linezolid may be used under operational research conditions as an alternative to the longer regimen.
This Rapid Communication has been released in advance of the updated guidelines expected in 2020, to inform national TB programmes and other stakeholders about the key implications for treatment of MDR/RR-TB and XDR-TB in order to allow for rapid transition and planning at the country level.
Accelerated efforts to address the MDR-TB crisis are essential to end the global TB epidemic and achieve the targets of the UN High Level Meeting political declaration, WHO End TB Strategy and the UN Sustainable Development Goals.
In 2020, WHO will convene a Global Consultation to inform countries, technical partners, donors and civil society on the key changes in the updated Consolidated Guidelines on the Treatment of Drug-Resistant TB. The meeting will aim to support countries to update their national guidelines, inform programme budgets and enable monitoring systems to facilitate rapid transition to more effective treatment regimens for patients with drug-resistant TB.
“The treatment landscape for patients with drug-resistant TB continues to improve thanks to research that is generating new evidence. We would like to thank patients, countries, technical partners, donors, civil society and other key TB stakeholders for their support throughout this guidelines development process” said Dr Tereza Kasaeva, Director of the WHO Global TB Programme. “Now we ask for renewed political commitment and stakeholder support to work with national TB programmes to improve treatment outcomes for MDR-TB patients and save lives worldwide.”
The changes suggested in the rapid communication reinforce the Joint Statement issued by the WHO Director General Dr Tedros Adhanom Ghebreyesus and WHO Civil Society Taskforce on TB. In addition, in advance of the Guideline Development Group meeting, a series of consultations were held with civil society representatives and partners through webinars and calls on the MDR-TB guideline development process by the WHO Global TB Programme, the Office of the WHO Chief Scientist and other departments.
(1) MDR-TB: Resistance of Mycobacterium tuberculosis against at least isoniazid and rifampicin, the cornerstone medicines for treatment of TB. Rifampicin-resistant disease on its own requires similar clinical management as MDR-TB.
(2) XDR-TB: Resistance of Mycobacterium tuberculosis to any fluoroquinolone and to at least one of three second-line injectable drugs (capreomycin, kanamycin and amikacin), in addition to multidrug resistance.