NEW TREATMENT FOR Tuberculosis - SCIENCE
India
is getting ready to introduce the BPaL (Bedaquiline, Pretomanid, and
Linezolid) regimen for all multi/extensively
drug-resistant tuberculosis (M/XDR-TB) patients.
About
Multi Drug Resistant TB
- Mycobacterium Tuberculosis,
the bacteria that cause tuberculosis (TB) can develop resistance to the
antimicrobial drugs used to cure the disease.
- Multidrug-resistant TB (MDR-TB) is
TB that does not respond to at least isoniazid and
rifampicin, the 2 most powerful anti-TB drugs.
- Most people with TB are cured by a
strictly followed, 6-month drug regimen that is provided to patients with
support and supervision.
- Inappropriate or incorrect use of
antimicrobial drugs, or use of ineffective
formulations of drugs (such as use of single drugs, poor quality
medicines or bad storage conditions), and premature treatment interruption
can cause drug resistance, which can then be transmitted, especially in
crowded settings such as prisons and hospitals.
- Extensively drug-resistant TB
(XDR-TB) is a rare type of
multidrug-resistant tuberculosis (MDR TB) that is resistant to
isoniazid and rifampin, plus any fluoroquinolone and at
least one of three injectable second-line drugs (i.e., amikacin,
kanamycin, or capreomycin).
- It has been reported in 1117
countries worldwide.
Tuberculosis (TB)
- It
is an infectious disease that most often affects the lungs and is caused
by the bacteria Mycobacterium tuberculosis.
- It
spreads through the air when infected people cough, sneeze or spit.
- It
can manifest in two forms: Latent TB infection and Active
TB disease.
- In Latent
TB infection, the bacteria are present in the body, but the immune system
keeps them in check, and the person does not exhibit symptoms.
However,
the bacteria can become active later, leading to active TB
disease, which is characterised by symptoms such as persistent cough,
chest pain, weight loss, fatigue, and fever.
Symptoms: prolonged cough (sometimes with blood), chest pain, weakness,
fatigue, weight loss, fever, night sweats.
BPaL
(Bedaquiline, Pretomanid, and Linezolid) Regimen
- Bedaquiline: An
essential component of the regimen, bedaquiline has proven effective
against drug-resistant TB.
- Pretomanid:
This drug, when combined with bedaquiline and linezolid, forms the BPaL
regimen. It’s a six-month, all-oral treatment.
- Linezolid:
Another critical player in the regimen, linezolid complements the other
drugs.
Why
Is This Significant?
- BPaL Regimen has shown promising
results in countries like Pakistan, South Africa, and Ukraine.
- It’s a game-changer because it
significantly shortens treatment duration. Previously,
patients endured 18 to 24 months of treatment; now, BPaL brings it down
to around six months by taking three tablets a day.
Impact
- The move to BPaL should improve
treatment outcomes and benefit thousands of patients.
- India currently
has a 56% treatment success rate for MDR/RR-TB cases and 48%
for XDR-TB cases. BPaL aims to boost these numbers.
Affordability
- The cost breakdown for
BPaL (Bedaquiline, Pretomanid, Linezolid, and sometimes Moxifloxacin) is
encouraging. The price is US$426, making it more accessible.
Steps
Taken by Government of India to Eliminate TB
- Revised
National Tuberculosis Control Program (RNTCP)
- National
Tuberculosis Elimination Program (NTEP): National Strategic Plan
(2017-25) for Ending TB by 2025.
- Pradhan
Mantri TB Mukt Bharat Abhiyan (PMTBMBA) (additional nutritional,
diagnostic and vocational support)
- Universal
Drug Susceptibility Testing (DST) (to provide universal access to
drug susceptibility testing, helping to identify drug-resistant strains of
TB early and tailor treatment accordingly)
- Ni-kshay
Portal
Source: https://www.thehindu.com/sci-tech/health/india-to-roll-out-bpal-regimen-for-all-mxdr-tb-patients/article68505496.ece