GTN: IMA TB Initiative
New WHO report highlights TB as a global priority for research and development
A recently released new report from the World Health Organization (WHO) “Antibacterial Agents in Clinical Development An analysis of the antibacterial clinical development pipeline, including tuberculosis” portrays a grim scenario by highlighting the lack of new antibiotics under development to combat the growing threat of antimicrobial resistance, which has emerged as a serious global public health concern.
Along with other priority antibiotic-resistant pathogens and Clostridium difficile, the report also focuses on Tuberculosis (TB) as a global priority for research and development. It draws attention to the fact that only seven new agents for TB are currently in clinical trials. Of these, four are in phase-1, and only one compound is in phase-3. This means that physicians have limited or no options for multidrug-resistant Mycobacterium tuberculosis (MDR-TB), particularly extensively drug-resistant M. tuberculosis (XDR-TB). Perhaps, in acknowledgement of this lack of therapeutic options, the Report also says, “This is especially problematic because treatment of TB infections requires a combination of at least three antibiotics. Novel treatment regimens of short duration that are assembling non-toxic drugs are desperately needed.”
The seven agents being developed specifically for treatment of TB include pretomanid (nitroimidazole), delpazolid (oxazolidinone), SQ-109 (diamine), GSK-3036656 (Leu RS inhibitor[oxaborole]), Q-203 (imidazopyridine amide), PBTZ-169 (DprE1 inhibitor [benzothiazinone]) and OPC-167832 (DPrEq inhibitor). Only two new antibiotics for treatment of MDR-TB, bedaquiline and delamanid, have reached the market in more than seven decades.
Bedaquiline has been introduced in India under Conditional Access Programme (CAP) to as treatment for MDR-TB as part of RNTCP at six identified tertiary centers.
India has highest burden of both TB and MDR TB in the world. According to the Global Tuberculosis Report 2016, six countries, including India accounted for 60% of the new cases of TB in the world. The number of new tuberculosis cases in a year went up to 2.8 million in 2015. Along with China and the Russian Federation, India accounted for 45% of the combined total of 580,000 cases of MDR-TB globally, including rifampicin-resistant TB (RR-TB). About 1.3 lakh incident MDR-TB cases occur annually in India (TB India 2017 Report).
TB is therefore a national public health emergency in India. Given the lack of innovative treatment options, as highlighted in the latest WHO report, there is a need for a concerted effort from all stakeholders including health care providers and policy makers, to check the emergence and spread of MDR-TB.
Inaccurate diagnosis and/or delayed diagnosis, especially detection of latent TB (infected but asymptomatic patients) and incomplete treatment are factors propagating the epidemic of MDR TB in the country. Control of infection by timely diagnosis and treatment will prevent further transmission of TB.
This is why, Indian Medical Association (IMA) has launched a campaign “IMA TB Initiative: GTN” to control this preventable and curable disease, where G stands for diagnosis of TB using GeneXpert test, T is for tracing the contacts and treating them and N stands for Notifying (mandatory) TB patients.
All of us should actively support this initiative. Because, it is only through a united and collaborative effort that this public health threat can be controlled.