WHO updates treatment guidelines for multidrug-resistant TB

Adrian Thomas MD Johnson & Johnson

Adrian Thomas

The WHO has announced changes to treatment guidelines for multidrug-resistant tuberculosis.

"The treatment landscape for patients with multidrug-resistant tuberculosis (MDR-TB) will be drastically transformed," Soumya Swaminathan, MD, WHO Deputy Director General for Programs, said in a press release.

A new order of available drugs for MDR-TB was "based on a careful balance between expected benefits and disadvantages", said the WHO. The preferred treatment options now include a full oral regimen.

To prepare countries for the changes to take place, the WHO has released a rapid communication to explain the new order of available drugs for MDR-TB.

Longer MDR-TB regimes were divided into three groups. Group A drugs levofloxacin / moxifloxacin, bedaquiline and linezolid are given priority. Medicines in group B include clofazimine and cycloserine / terizidone. Finally, if Group A and Group B drugs can not be used, medicines from Group C – including ethambutol, delamanid, pyrazinamide, imipenem-cilastatin, meropenem, amikacin (streptomycin), ethionamide / prothionamide and p-aminosalicylic acid – can also be included to complete the regimen.

WHO no longer recommends kanamycin and capreomycin because they have an increased risk of treatment failure and recurrence when used in longer MDR-TB regimens.

The new guidelines give priority to oral medicines, such as bedaquiline, and minimize injectables, which can cause pain and anxiety in the patient and serious adverse events that lead to an interruption of treatment, the WHO said.

The WHO also based the rankings on the results of drug-sensitivity tests (DST), the reliability of existing DST methods, population level resistance levels, history of previous use of medicines in a patient, tolerability of medicines and possible drug interactions.

In a statement, Médecins Sans Frontières praised the renewed treatment regimen of the WHO and called on Johnson & Johnson to lower the price of bedaquiline, the first drug specifically developed to treat MDR-TB. The drug was made by Janssen Pharmaceuticals, a subsidiary of Johnson & Johnson.

"At Johnson & Johnson, ensuring access to bedaquiline for eligible patients is our top priority and a responsibility that we take very seriously," Adrian Thomas, MD, vice president of global public health and access at Johnson & Johnson, told Infectious Disease News.

"Therefore, in July 2018 – inspired by South Africa's leadership and commitment to replace less effective and toxic injectable drugs with bedaquiline for all patients with MDR-TB – we announced the price of bedaquiline to $ 400 for South Africa. While waiting for other countries to follow their lead and catalyze further action against MDR-TB, we will also offer the same special effort prize to eligible National Treatment Programs & # 39; s and [nongovernment organizations] purchasing through the Stop TB Partnership Global Drug Facility. "

Later this year, WHO said the "consolidated, updated and more detailed" MDR-TB treatment policy guidelines will be released. On September 26, 2018, world leaders will meet in New York for the very first meeting of the United Nations General Assembly on high-level tuberculosis.

"Building on the available new data, and with the involvement of a large number of stakeholders, the WHO has made progress in rapidly reviewing the evidence and communicating the key changes needed to ensure the survival of MDR TB patients worldwide. improve, "Swaminathan. "The political momentum must now be urgently stepped up if the global crisis of MDR-TB is to be limited." – by Marley Ghizzone


WHO. Rapid communication: major changes in the treatment of multidrug and rifampicin-resistant tuberculosis (MDR / RR-TB). http://www.who.int/tb/publications/2018/rapid_communications_MDR/en/. Accessible on August 21, 2018.

revelations: Swaminathan works for the WHO. Thomas works for Johnson & Johnson.

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