This drug could change TB guidance globally

An interesting research pioneered by McGill University Health Centre in Canada, is set to change TB guidance around the world, especially when one quarter of the global population is thought to have latent TB infection.

It’s because the long course of drugs currently used, can have toxic effects on the liver, many infected people go untreated and some suffer harm.

Two groundbreaking studies, one in adults and the other in children, have trialed a less toxic drug than the one in current use worldwide for latent TB that can cut the treatment time from nine months to four. A new, shorter and safer drug regime for latent tuberculosis could help curb the global epidemic by increasing the numbers successfully treated and reducing the pool of infection, researchers believe.

People infected with latent TB may not become ill themselves, but if they then develop active TB they may transmit the infection to others. It is generally recognized that the chances of making real progress against the TB epidemic are slim unless the pool of latent infection can be reduced.

There were an estimated 10.4m new cases of active TB in 2016 and 1.7 million people died from the disease, according to the World Health Organization.

The standard treatment for latent TB at the moment is a lengthy course of isoniazid – for nine months. The World Health Organization (WHO) recommends six months, largely for cost reasons. Whether one takes the treatment for four, six or nine months, it has significant side effects, particularly on the liver. Dr Richard Menzies from McGill who led the new research says one can have liver failure.

In the studies, adults and children with latent TB infection were given a different antibiotic called rifampin. The results, published in the New England Journal of Medicine, showed that four months of rifampin were as good as nine months of isoniazid. “What we’re showing is that you don’t need isoniazid at all,” said Dr Menzies.

Developing countries struggle to treat active TB, let alone latent TB, but the middle-income countries like Brazil and India treat relatively few people with latent TB because of their fears of the side-effects of isoniazid.

Dr Menzies, who has been involved in the writing of the US and Canadian guidelines on TB treatment, believes these and the WHO guidelines will now change.

Tags: , , ,