On 17 August 2018, the World Health Organization (WHO) published a Rapid Communication policy brief announcing the initial outcomes of the guideline development group meeting on the management of multidrug-resistant tuberculosis (MDR-TB), which took place 16-20 July 2018. The policy brief outlines changes to WHO’s recommended treatment approaches for MDR-TB and rifampicin-resistant TB (RR-TB), based on the most recent evidence on safety and efficacy. WHO will provide more detailed guidance in a final revision of its treatment guidelines before the end of 2018.
In response to the publication of the Rapid Communication, Dr. Paula I. Fujiwara, Scientific Director, The Union, made the following statement:
"The policy brief describes changes to WHO’s current guidelines, outlining a recommended approach for both long- and short-course treatment regimens. The brief de-prioritises the use of injectable medicines within the long-course MDR-TB treatment regimen. The Union recognises the challenges, including the risk of permanent hearing loss, that people undergoing treatment for MDR-TB face in the course of receiving injectable medicines and welcomes the move away from their routine use.
“The long-course MDR-TB treatment regimen approach outlined in the policy brief is still recommended for some patients, requires a minimum 18-20 months and still contains drugs with toxic side effects. The Union urges treatment providers to prioritise a person-centred approach to all TB care to ensure that patients are supported for the duration of their treatment, including through the use of psychosocial support. The Union will continue to support countries to best organise the delivery of MDR-TB diagnosis and treatment with best practices including active drug safety monitoring and management.
“The standardised nine-month treatment regimen recommended by WHO in 2016, although it still includes an injectable agent, offers a shorter treatment regimen to eligible patients that leads to comparable success rates and fewer treatment interruptions compared with the long-course regimen. The Union continues to support efforts to develop an even shorter, all-oral regimen for MDR-TB via the STREAM Stage 2 clinical trial and advocates for treatment approaches that ensure an equal opportunity for all DR-TB patients to be treated successfully. The Union is also advocating, ahead of the first ever UN High-Level Meeting on TB later this year, with heads of state and governments to work with stakeholders in the public, private and non-profit sectors close the annual $1.3 billion funding gap in TB research and development.
“The Union looks forward to the publication of the full revised guidelines and accompanying handbook in the coming months, and will volunteer experts to participate in WHO’s multi-stakeholder Task Force to assist countries in the implementation of the revised guidelines.”