MDR-TB: STREAM trial vindicates Bangladesh way that 9-month treatment as effective as 2 years

The world’s first multi-country randomised clinical trial to test the efficacy, safety and economic impact of shortened multidrug-resistant tuberculosis (MDR-TB) treatment regimens has proved what Bangladesh has shown before.

Nurul Islam Hasibfrom Guadalajara in Mexicobdnews24.com
Published : 13 Oct 2017, 04:02 PM
Updated : 13 Oct 2017, 05:14 PM

The much-awaited result of the Standardised Treatment Regimen of Anti-TB Drugs for Patients with MDR-TB or STREAM trial was released on Thursday at the ongoing 48th Union’s world conference on lung health at Guadalajara.

It showed that the nine-month regimen is “very close to the effectiveness” of the 20-24 month regimen recommended by the WHO in 2011.

However, Bangladesh has already started that nine-month regimen to treat this dangerous form of tuberculosis after the country’s own research received World Health Organisation’s (WHO) approval.

Bangladesh showed that using a combination of available drugs in different doses can reduce the treatment course to nine months. This study was again conducted in nine French-speaking African countries which showed similar results.

But the UN agency when it recommended in favour of shortening the regimen last year under some conditions had said that this recommendation is based on “very low certainty in the evidence”.

That prompted The Union, which is the authority of lung diseases, to help carry out a clinical trial in seven sites in Vietnam, Mongolia, South Africa, and Ethiopia.

Now the new results show nine-month and 20-month regimens are very close in terms of efficacy.

ID Rusen, Union lead for the STREAM trial, said the nine-month regimen “did as well or even better than we expected given the rigorous standards of the clinical trial”.

Dr Paula Fujiwara, Scientific Director of The Union, said they are “pleased with the performance of the nine-month regimen in the STREAM trial".

“We believe that this regimen has been shown to be feasible to implement in the field and should continue to result in good treatment outcomes for patients.”

“We believe that the results support the current WHO recommendation to change to a shortened regimen for many patients, and that close monitoring remains an important feature of the regimen,” she said.

In terms of the economic burden of MDR-TB, health economics analysis conducted by the Liverpool School of Tropical Medicine show the nine-month regimen reduced the cost to the health system for each patient by at least a third.

It has a reduction in pill burden by approximately two-thirds compared with the 20-24 month regimen.

The Union said follow-up of this Stage 1 of the trial is ongoing, and full results will be published next year, which will include data from the final follow-up visits.

“These additional data are unlikely to materially change the results,” it said.

TB is one of the oldest diseases to infect humans and now ranks alongside HIV/AIDS as the top infectious killer worldwide. The WHO says MDR-TB comprises three percent of new TB cases globally.

It is defined as forms of TB that are resistant to at least the two first-line antibiotics - isoniazid and rifampicin. The WHO considers it a ‘public health crisis’ that affected an estimated 480,000 people in 2015.

Bangladesh estimates the MDR-TB rate 6 per 100,000 people. The government distributes all TB drugs free as part of a national programme.