WHO approves oral Bedaquiline as frontline TB drug for all MDR cases

The World Health Organisation (WHO) for the first time on Friday recommended the new oral anti-tuberculosis (TB) drug Bedaquiline as the frontline medicine for treatment of all multi-drug-resistant (MDR) TB cases. Earlier, the drug was recommended only for patients with extremely drug-resistant (XDR) cases, for whom all other medicines had failed.

At present, MDR cases are treated with injectables of medicines such as Kanamycin and Capreomycin, along with another group of medicines called fluoroquinolones, but this is known to lead to side-effects such as hearing loss and kidney-related problems. Patients have to visit a nearby facility for every day for six months to take injections. This is one of the primary reasons for patients to drop treatment midway.

Stobdan Kalon, medical coordinator at the international non-profit Médecins Sans Frontières (MSF; also known as Doctors Without Borders), said WHO’s endorsement of Bedaquiline as the frontline drug for all MDR cases was a much-needed step. “They have upgraded Bedaquiline in the hierarchy of second-line TB drugs and downgraded the use of injectables,” he told HT. He added that the recommendations mean that MDR patients could do away with injections, “which would be great for India where we have such high levels of flouroquinolone resistance.” He said, “We hope the Revised National TB Control Program (RNTCP) implements these guidelines soon in the country.”

In India, the use of Bedaquiline has scaled up in the last two years, but is only given to patients with XDR TB for whom all other drugs have failed. Currently, around 250 XDR patients from Mumbai are on the drug.

Dr Vikas Oswal, a Mumbai-based chest physician, however, cautioned that implementing WHO recommendations may not be easy in India as there is already significant drug resistance to fluoroquinolones. “Bedaquiline has to be given with other second-line drugs. If we stop the injectables, we won’t have drugs that will work with Bedaquiline as there is already close to 74% resistance to fluoroquinolones, which are recommended for use along with Bedaquine as per the new WHO guidelines,” he said.

India accounts for the highest burden of TB cases in the world. The World Health Organisation (WHO) estimated that there were 27.9 lakh new TB cases in India, of which nearly 6% were drug resistant. Close to 2.8 lakh people die of TB in India annually.

First Published: Aug 17, 2018 23:55 IST

Updated: August 18, 2018 — 12:25 am