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Treating drug-resistant TB

Date: 15 March 2020 Tags: Miscellaneous

Issue

A small trial (Nix-TB) undertaken at three sites in South Africa to test the safety and efficacy of three oral drugs, bedaquiline, pretomanid and linezolid, in patients with extensively drug-resistant TB (XDR-TB) and multidrug-resistant TB (MDR-TB) showed encouraging results.

 

Background

Of the 98 patients who were successfully treated using the three drugs, 63 patients had XDR-TB and 35 had MDR-TB. The treatment success rate was 89% (63 of 71) for XDR-TB and 92% (35 of 38).

 

Details

  • The treatment using the three oral drugs lasted for 26 weeks and was followed-up for six months after the end of the treatment. Patients received the treatment daily for 26 weeks.

  • The 90% treatment success in the case of hard-to-treat patients is at par with the success rate seen while treating drug-sensitive TB.

  • Of the 109 patients treated, 11 had unfavourable outcomes while 98 had favourable outcomes. Of the 11 patients who had unfavourable outcomes, there were seven deaths and two had a relapse during the six-month follow-up period.

  • The MDR-TB patients included in the trial were either not responsive to standard treatment or had discontinued treatment due to side effects.

  • Of the three drugs used in the trial, a “high-percentage” of patients experienced adverse effects related to linezolid drug.

  • Of the 109 patients treated, 88 patients (81%) had peripheral neuropathy (weakness, numbing and pain usually of hands and feet due to nerve damage), though the symptoms were mild to moderate in the majority of cases.

  • Two patients developed optic neuritis, where the optic nerve becomes inflamed, which was resolved when linezolid drug was withdrawn.

  • Also, 40 had anaemia, while eight patients had adverse event of the liver and the regime had to be interrupted.