Union response to WHO updated treatment guidelines for multidrug- and rifampicin-resistant tuberculosis

In response to the publication of new guidelines from the World Health Organization (WHO) on the treatment of multidrug-resistant tuberculosis (MDR-TB), Dr. Paula I. Fujiwara, Scientific Director, The Union, made the following statement:

“The latest guidelines from WHO on the treatment of MDR-TB continue to support a move towards an all oral regimen.  The Union recognises the challenges, including the risk of permanent hearing loss, that people undergoing treatment for MDR-TB face in the course of receiving injectable medicines and welcomes the move away from their routine use.

“The Union continues to support ongoing research into how modifications to the standardised nine-month treatment regimen (STR) recommended by WHO in 2016, to obtain the same or higher cure rates as the original one, be less toxic and avoid any amplification of resistance. As part of this approach, The Union will work with countries and programmes to develop studies in appropriate operational research conditions on the removal of the second line injection (SLI), with discussions already started with countries regarding the role of linezolid (LZD), delamanid (DMD), and bedaquiline (BDQ), as the replacement for SLI.

“The standardised nine-month treatment regimen, although it still includes an injectable agent, offers a shorter treatment regimen to eligible patients that leads to comparable success rates and fewer treatment interruptions compared with the long-course regimen. The Union works closely with national TB programmes and is recommending and supporting countries wanting to continue the STR (STREAM based regimen) in the short term to change from kanamycin (KM) to amikacin (AM), in line with the WHO recommendations.

“Regardless of what regimen is offered to patients, all the regimens in this new guideline continue to be long, between nine and 20 months, and contain drugs that may cause the patient severe side effects. As such, The Union urges treatment providers to prioritise a person-centred approach to all TB care to ensure that patients are supported for the duration of their treatment, including through psychosocial support.

“The Union promotes that ahead of enrolment on MDR-TB treatment, all patients should receive appropriate counselling to enable informed and participatory decision-making into their treatment. It is important that patient information material is up-to-date and reflects the new changes in a language and way that patients can understand so that they are appropriately informed about their treatment options.

“The Union will continue to support countries to best organise the delivery of MDR-TB diagnosis and treatment with best practices including active drug safety monitoring and management.

“The Union hopes this will be the first of many updates to the MDR-TB treatment guidelines with clinical trials into shorter, less toxic all oral regimens underway.”