SEATTLE, Washington — Tuberculosis is the leading infectious cause of death in the world, surpassing AIDS as of 2014. The disease, a bacterial infection that attacks the lungs, killed 1.5 million people in 2014, compared to the 1.2 million who dies from AIDS. Though the death rate due to TB is half of what it was 25 years ago, a lack of global funding limits research and treatments. Yet, a break-through in medicine may cure the deadliest strain of the disease: XDR. The new XDR medicine is the next step in saving lives.
The XDR Strain of TB
The Extensively Drug-Resistant (XDR) Tuberculosis, first appeared in 2006 where it was found to be in 28 countries. It is resistant to most first-line tuberculosis drugs, such as isoniazid and rifampin, and some second-line drugs. Though uncommon, it has the highest death rate. Experts believe that three-fourths of patients die before even receiving an XDR diagnosis. Of those who are treated, only 34 percent survive.
There are 30 thousand people in 100 countries suffering from the XDR strain, and treatment is brutal for them. In South Africa, a typical regimen consists of a daily regime of 40 pills for a duration of up to two years. Many of the medicines come with brutal side-effects, including loss of vision, nausea and psychosis. For many, the side-effects are too great, and patients are unable to undergo the full course of their treatment.
Drug-resistant tuberculosis can arise from incomplete treatment. This may then be passed onto others, even if they’ve never undergone treatment for TB. HIV, which weakens the immune system, makes those exposed to TB 25 times more likely to develop the infection. XDR poses a massive threat if not contained.
New Drug Trials Showing Positive Results
In August 2019, the FDA approved pretomanid tablets for the treatment of XDR TB. The nonprofit TB Alliance developed pretomanid and hopes to release the drug for worldwide use. Further trials were launched for linezolid, which can be dangerous in prolonged use. The FDA and World Health Organization had approved bedaquiline for use in multi-drug resistant strains of tuberculosis in 2012 and 2015.
However, a trial for a new drug was run in South Africa, a country that had seen the world’s worst TB epidemic in 1996. The Nix-TB trial put patients on a six-month regimen with five pills daily. It is formally called the BPaL regimen for the three drugs involved: bedaquiline, pretomanid and linezolid. The new XDR medicine, compared to previous treatments, features three “killer” drugs rather than two and supporter medications. The results were unprecedented. The trial included 107 patients, of whom 95 experienced successful results during the six months, and six months following.
Keeping Treatment Affordable
Médecins Sans Frontières (MSF), a humanitarian medical assistance organization that works in more than 70 countries, has called on TB Alliance to keep the drug at an affordable price. The drug was developed from funding from multiple countries, including Australia, Germany, the U.K. and the U.S. It received the international funding under those promise of providing “affordable treatment,” says Sharonann Lynch, HIV and TB policy advisor for MSF’s Access Campaign.
MSF, which has aided in more than 11 million outpatient consultations, hopes that the medicine will be available to everyone since the disease that can affect anyone. MSF estimates that generic pretomanid could be sold for only $0.36 to $1.14 per day and still show a profit. They demand that a complete course of the medication should cost no more than $500.
With enough funding and innovation, a disease that was deemed hopeless in 2006 has the potential for a cure. The new XDR medicine offers previously unseen survival rates and already has government support. With careful steps, the world may soon see one of the deadliest diseases alleviated.
– Katie Hwang