The need to accelerate access to new drugs for multidrug-resistant tuberculosis

Abstract

Approximately half a million people are thought to developmultidrug-resistant tuberculosis annually. Barely 20% of these peoplecurrently receive recommended treatment and only about 10% aresuccessfully treated: Poor access to treatment is probably driving thecurrent epidemic, via ongoing transmission. Treatment scale-up ishampered by current treatment regimens, which are lengthy, expensive,poorly tolerated and difficult to administer in the settings where mostpatients reside. Although new drugs provide an opportunity to improvetreatment regimens, current and planned clinical trials hold littlepromise for developing regimens that will facilitate prompt treatmentscale-up. In this article we argue that clinical trials, whilenecessary, should be complemented by timely, large-scale, operationalresearch that will provide programmatic data on the use of new drugs andregimens while simultaneously improving access to life-saving treatment.Perceived risks - such as the rapid development of resistance to newdrugs - need to be balanced against the high levels of mortality andtransmission that will otherwise persist. Doubling access to treatmentand increasing treatment success could save approximately a millionlives over the next decade..