17 January 2001
FEWER PILLS HELP THE MEDICINE GO DOWN FOR TBPATIENTS — AND COMBAT A DEADLY EPIDEMIC
Patients suffering from tuberculosis now have an alternative form of treatment involving far fewer pills — currently up to 16 a day — to cure their disease. Experts writing in the January issue of the Bulletin of the World Health Organization say the new treatment, which reduces the number of tablets to as few as three or four per day, will also combat the spread of drug-resistant forms of the deadly disease, especially in the world's worst-affected countries.
Proposed by the World Health Organization (WHO) in the mid-1990s but not yet adopted by all countries, the new treatment has recently become cheaper and therefore more accessible even to people in the poorest countries.
The proposed treatment replaces individual tablets of the different drugs with fixed-dose combination tablets (FDCs), which contain up to four different drugs. This solution would mean hundreds fewer tablets that each patient has to swallow over the whole course of treatment.
The authors of the Bulletin article are members of an international team of TB experts — Dr Bjorn Blomberg, of Bergen University, Norway, Dr Sergio Spinaci, of WHO, Geneva, Dr Bernard Fourie, of the Medical Research Council, Pretoria, South Africa, and Dr Richard Laing, of Boston University, USA.
"It is important that FDCs become part of government policy in all countries, especially in the 22 TB high-burden countries," Dr Spinaci said today. "Until recently the cost of fixed-dose combinations was higher than the sum of the costs of the individual single-drug tablets," he said. "But in the past year the cost of a full course of TB treatment using FDCs has dropped to about the same as that of individual drugs. With their increasing use, cost is no longer an obstacle to the wider implementation of this treatment. For the poorer countries with the highest burdens, this is particularly good news."
Currently there are an estimated eight million new TB cases a year and at least two million TB deaths a year worldwide. Eighty per cent of the cases occur in 22 "high burden" countries, mostly in Asia and Africa.
The mainstay of treating TB is with a combination of several different medicines, given under supervision. Typically, TB patients have to take as many as 16 pills a day for at least two months, and then up to nine pills a day for a further four or six months, in order to recover fully. Many patients fail to stay the course, which denies them a cure, and favours the development and spread of drug resistance.
The authors explain that the FDCs are being recommended by WHO and the International Union Against Tuberculosis and Lung Disease, and are now being used in about 40 countries. They urge tuberculosis treatment programmes in other countries to begin using the FDCs.
The authors say in the Bulletin article: FDCs simplify the prescription and supplyof drugs and may also limit the risk of drug-resistant tuberculosis arising.
"One of the constraints in the conventional treatment is that patients have to take a large number of tablets. Having fewer pills to swallow makes treatment easier and minimizes the probability of splitting the doses or of taking only some of the drugs in the regimen.
"In view of the enormous costs and difficulties in treating drug-resistant tuberculosis, the highest priority must be given to preventing the emergence of drug resistance in the first place.
"The most important step is to ensure adequate treatment of all TB patients. Acquired resistance most commonly follows erratic drug-taking, that is, interrupting treatment frequently and for long enough to allow re-growth of bacteria which might favour resistant mutants.
"Multiple interruptions of treatment have been shown to be the predominant cause of drug resistance."
The authors emphasize that although the use of FDCs simplifies prescribing and drug-taking, it does not eliminate the need for direct observation of TB treatment.
Dr Spinaci added: "The pioneering work in the area of FDCs is a benchmark and an example of how fixed-dose combinations could be developed for use in the treatment of other infectious diseases such as malaria and HIV/AIDS."
For further information please contact Mr John Maurice, WHO, Geneva, Tel: (+41 22) 791 3722; email:firstname.lastname@example.org Web site: www.who.ch/int-bulletin