Niger study results show effective, safe and applicable use of the shorter treatment regimen for drug-resistant TB

A retrospective observational study, evaluating the management of rifampicin-resistant tuberculosis (RR-TB) in Niger from 2008 to 2016 following the national roll out of the shorter treatment regimen, achieved 83 percent relapse-free success. This successful outcome was not affected by initial resistance to ‘companion drugs’, used in the regimen to ensure that no resistance is acquired to the ‘core drug’, or the one drug in a regimen that contributes most to relapse-free cure.

Acquisition of resistance to fluoroquinolones was very uncommon and the few patients who were declared failure or relapse after cure, were successfully treated with bedaquiline-based regimens. 

In addition, by carefully monitoring the hearing of all those in treatment, health providers were able to reduce hearing loss (a side effect of the injectable used) by switching to a second-line medication at the first sign of damage. No serious hearing loss was recorded since January 2016.

This is the first study of its kind to report on a comprehensive approach to countrywide RR/multidrug-resistant TB (MDR-TB) management, by analysing the number of persons tested, diagnosed with and enrolled on treatment, and their treatment outcomes. In addition, the study estimated predictors of unfavourable outcome, including the effect of initial resistance to the regimen’s companion drugs on outcomes, which had not previously been exhaustively reported.

“The results show that a comprehensive approach to RR/MDR-TB diagnosis and management is feasible and can be implemented with good treatment outcomes even in resource-limited settings such as Niger”, said Dr Alberto Piubello, Coordinator of the MDR-TB Programme at The Union, and lead author of the study.

“Drug resistance threatens our TB eradication efforts with more than 480,000 people infected in 2018 alone. This study provides clear data on the effectiveness, safety and applicability of the shorter treatment regimen”, said Dr Puibello.

The shorter treatment regimen used in this study has been implemented nationwide in Niger for RR-TB since 2008, through collaboration between the National TB Programme and the Damien Foundation, with technical support from The Union.

After the encouraging preliminary results of a modified all-oral regimen for patients with ototoxicity, Niger is planning to implement all-oral regimens for MDR-TB in operational research conditions. 

The paper, Management of multidrug-resistant tuberculosis with shorter treatment regimen in Niger: Nationwide programmatic achievements, has been published in the January edition of Respiratory Medicine.