Page 46

TB & DR-TB TREATMENT

OUT OF STEP 2017 WHAT NEEDS TO HAPPEN TB REGIMEN DEVELOPMENT Since TB must be treated with combinations of medicines, the most effective research focuses on entire regimens and strategies to optimise them, instead of developing medicines one by one. The ultimate goal is to develop an affordable, short-course, oral ‘pan-TB’ regimen with few side effects. 3P: The 3P Project is dedicated to initiating a better, faster way to develop a short-course pan-TB regimen, instead of developing single medicines. The 3P Project has built affordability into drug development, because their costs are covered up front: prize money goes towards early-stage development, grants pay for trials that combine new medicines, an open collaborative platform ensures access for developers, and the pooling of data, intellectual property and products ensures accelerated and affordable access. Several studies (including NC-005, NIX, TB PRACTECAL and endTB) are looking to increase effectiveness and shorten treatment duration by combining old, new and repurposed medicines with some promising TB medicines that are in the development pipeline, such as pretomanid – a medicine from the same family as delamanid - and sutezolid, which may be more tolerable than linezolid.119

 EDICINES: ACCESS M AND AFFORDABILITY Medicines need to be available and affordable to be effective. A conventional, WHO-recommended, standard 24-month treatment course for MDR-TB can cost between US$ 1,600 and US $ 4,000; this does not include clinical management, laboratory tests and hospitalisation, which can be up to 14 times higher than the price of the regimen. Currently, the price of delamanid in countries eligible for the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) is US$ 1,700 for a 6-month course. Current pricing for a 6-month course of bedaquiline is US$ 900 in low- and middle-income countries (LMICs), US$ 3,000 in middle-income countries (MICs), US$ 30,000 in high-income countries (HICs), US$ 1,700 in Russian Federation and US$ 1,351 in other countries in the Commonwealth of Independent States (CIS) countries; or, otherwise available through a donation programme for GFATM eligible countries outside of CIS.120

46

Médecins Sans Frontières and Stop TB Partnership – July 2017

Treatment gap: More effort is needed to close the deadly gap between adults and children who need treatment and those who are actually receiving it, for all forms of TB. Co-infections: Co-infections should be managed effectively, especially TB/HIV co-infection. Paediatric TB: Countries should introduce the updated paediatric FDCs as the standard of care for DS-TB. Optimal DR-TB therapy: • Steps should be taken to reduce the burden on people receiving treatment; • Use of newer classes of TB medicines should be scaled up: in 2016, only 5% of people who could have benefited from treatment with bedaquiline or delamanid had access to these life-saving medicines; • DR-TB regimens should be affordably priced and accessible to people who need them in all LMICs; • As more data on new medicines become available, WHO should continue to update the guidance for introducing new medicines and update the WHO Model List of Essential Medicines (EML) with new and companion TB medicines; WHO should also adapt and conduct advanced DR-TB training on new medicines for technical advisors, NTPs, etc. R&D: Governments should support the launch of innovative research to develop new, affordable all-oral regimens that are shorter, have fewer side effects and have a lower pill burden. This includes the 3P Project, designed to use innovative funding and pooling mechanisms to develop a 1-month cure for all forms of TB.

결핵: 새 보고서 – 세계에서 가장 치명적인 감염병 결핵을 각국이 아직도 해결하지 않고 있다는 사실 드러내  

국경없는의사회와 세계보건기구(WHO) 산하 ‘결핵 퇴치 국제협력사업단’(Stop TB Partnership)은 ‘Out of Step’ 보고서 3판을 발표했다. 이 보고서는 세계에서 가장 치명적인 감염병인 결핵에 맞서기 위해 각국 정부가 더 큰 노력을...

결핵: 새 보고서 – 세계에서 가장 치명적인 감염병 결핵을 각국이 아직도 해결하지 않고 있다는 사실 드러내  

국경없는의사회와 세계보건기구(WHO) 산하 ‘결핵 퇴치 국제협력사업단’(Stop TB Partnership)은 ‘Out of Step’ 보고서 3판을 발표했다. 이 보고서는 세계에서 가장 치명적인 감염병인 결핵에 맞서기 위해 각국 정부가 더 큰 노력을...