Important note: Information in this article was accurate in 2002. The state of the art may have changed since the publication date.
Newsday - August 16, 2002
Laurie Garrett, Staff Writer
This good news comes at a time of desperate need for new strategies against TB, which was declared a global health emergency by the World Health Organization in 1993. Currently, the disease kills more than 2 million people annually worldwide.
The breakthrough will not solve the TB crisis, experts admit, but it can dramatically simplify treatment, especially in the United States and other wealthy countries. How applicable these findings may be for poor countries, where the bulk of all tuberculosis is, remains to be seen.
The new drug, called rifapentine, when taken in combination once a week with an old medicine called isoniazid, cures most TB patients as effectively and quickly as current standard therapies involving four or five drugs, taken two or even three times a week. These findings are the results of treatment of 1,000 patients in 23 clinics in the United States and Canada. Three of the clinical collaborators are Harlem Hospital, Columbia University's School of Public Health and New York University School of Medicine/Bellevue. The results appear in this week's issue of the British medical journal, The Lancet.
"It's a major advance," Dr. Wafaa El-Sadr, chief of infectious disease at Harlem Hospital, said in an interview. "It can make patient's lives much easier."
When treatment is easier for the patients, El-Sadr explained, they are far more likely to complete the many months of treatment necessary not only to cure them, but also render them noninfectious.
Simplifying treatment is critical for the types of patient populations El-Sadr sees in her Harlem Hospital setting - people whose lives are already, even in the absence of TB, extremely challenging.
"About 40 percent of them are HIV-positive," El-Sadr said of her patients. "If you ask, 'Have you ever been homeless?', about a third have. Unemployment is very, very high - about 70 percent. Increasingly the patients are foreign-born, mostly from western Africa. And when you look at substance abuse, both drugs and alcohol, it's about 40 percent."
Nationwide, TB takes hold in communities of acute poverty. The bacterium that causes tuberculosis makes treating that population tough because it is a slow-growing organism only vulnerable to drug therapy during certain times in its life cycle. It is also prone to developing resistance to the standard array of antibiotics. Effective therapy involves up to two years of regular medication, under a supervised regimen dubbed Directly Observed Therapy, or DOTs.
The new protocol means some TB patients need only come in once a week, which substantially reduces not only the hassles for the patients, but also the costs of clinical staffing, medication and other services, said Dr. Andrew Vernon of the Centers for Disease Control and Prevention. Vernon was co-chairman of the large study. He said the key to this breakthrough has been the longer half-life of the drug, rifapentine (trade name Priftin), which takes five times longer to break down in the body than its antecedent medicine, rifampin. One dose of the new drug, a tablet, carries a patient through an entire week.
There are limitations to the new treatment, however, which Vernon thinks restricts its use to wealthy countries. The approach is not effective if the patient has any of three complications: HIV infection, a chest X-ray that shows large levels of pulmonary infection or drug-resistant tuberculosis bacteria.
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