South Africa has just made history today as it becomes the first country in the world to take a bold step of replacing an injectable drug with toxic side effects, with a promising new oral medicine (bedaquiline) in the standard multidrug-resistant tuberculosis (MDR-TB) treatment regimens for adolescents and adults.
Doctors Without Borders (MSF) has welcomed the South African National Department of Health (NDoH)’s announcement and sees this as a positive step aimed at making MDR-TB treatment more tolerable, and reducing the devastating impact of side effects caused by the injectable agents.
“The standard treatment for MDR-TB is currently effective only 50% of the time, and includes a painful injectable antibiotic known to cause terrible toxic side effects, including kidney failure and hearing loss. Experience with bedaquiline in treating drug-resistant TB – mainly from South Africa - demonstrates improved clinical outcomes in people living with MDR-TB, and initial evidence shows that it can be safely and effectively used in place of the toxic injectable,” says MSF’s Dr. Anja Reuter, a DR-TB doctor in Khayelitsha in the Western Cape, where MSF has run a DR-TB programme since 2007.
Although there are still some hurdles in implementation, MSF has called on the government to support health facilities in developing capacity to use bedaquiline and other new drugs, and to manufacturers to reduce the prices they charge in South Africa and globally. Worldwide, more than half a million people are infected with MDR-TB every year but extremely few who could have benefited had access to newer TB drugs such as bedaquiline.
MSF is urging other countries and officials responsible for WHO guidance on the use of DR-TB medicines to follow South Africa’s progressive example and commit to replacing the toxic injectable drug and ensuring expanded global access to effective new medicines, including bedaquiline.