For Volodymyr, this Wednesday is a milestone: it is his last day of taking a new treatment for drug-resistant tuberculosis, which has been hailed as a turning point in the fight once morest the disease.
Previously, the 25-year-old doctor from kyiv (Ukraine) was undergoing another treatment: almost half as effective, involving more tablets, and which also caused him neurological side effects.
These disappeared when he switched to the new treatment, which he took for just six months, compared to two years for the previous one: “It was very easy,” Volodymyr, who did not wanted to give his last name.
A scan on Wednesday showed that he no longer showed signs of tuberculosis. He now plans to return to work next week following eight months of sick leave. “Now I can start living once more,” he rejoices.
Tuberculosis, formerly known as “phthisis”, was the biggest cause of infectious death before the arrival of Covid-19, with 1.5 million people dying each year.
About 5% of new cases are resistant to prescribed antibiotics, making them difficult to treat.
But a new drug regimen, called BPaL because it combines the three antibiotics bedaquiline, pretomanid and linezolid, has been seen as a major breakthrough since its approval by the US Food and Drug Administration (FDA) in 2019.
Research in 2020 showed that the BPaL diet cured over 90% of patients, but there was a high rate of linezolid-related side effects, including nerve pain or bone marrow depression (a drop in the production of cells responsible for immunity).
A study published Wednesday in the New England Journal of Medicine is a game-changer: it shows that the dosage of linezolid can be reduced by half without significantly reducing the effectiveness of the treatment.
A trial involving 181 participants with drug-resistant tuberculosis was conducted in Russia, South Africa, Georgia and Moldova – countries with high rates of tuberculosis.
It shows that if 1,200 milligrams of linezolid over six months works at 93%, this rate remains at 91% when the dose is reduced by half, to 600 milligrams.
In this trial, the number of participants with peripheral neuropathy, which causes nerve pain, fell from 38% to 24%, while the rate of bone marrow suppression fell from 22% to 2%.
“This is the beginning of the end of drug-resistant tuberculosis,” lead study author Francesca Conradie of the University of the Witwatersrand in South Africa told AFP. “The sooner you treat someone’s TB, the less contagious it is – it’s like Covid in many ways.”
It is also easier for patients to take BPaL: whereas previous treatments might involve 23 pills a day and up to 14,000 pills in total over two years, BPaL consists of five pills a day – less than 750 over six months.
For Nataliia Lytvynenko, who oversaw BPaL treatments in Ukraine, the more manageable amount of pills makes it easier for patients who have been displaced by war to continue treatment.
The World Health Organization said earlier this year that it would soon update its guidelines to recommend that most patients with drug-resistant tuberculosis use BPaL with 600 milligrams of linezolid.
These are “major advances”, underlined two experts in the field, not involved in Wednesday’s study.
The BPaL treatment “is one of the defining advances in scientific research on tuberculosis this century”, wrote Guy Thwaites of the British University of Oxford and Nguyen Viet Nhung of Vietnam’s National Tuberculosis Control Programme. in an editorial in the New England Journal of Medicine.
These advances come at a time when the Covid pandemic had raised fears of a certain number of brakes in the fight once morest tuberculosis.