The key strengths of the study were the diversity of the population (sites in seven countries on three continents, with different ethnic compositions and healthcare systems), the inclusion of participants co-infected with HIV, and a greater than 90% rate of retention, as well as significantly fewer failures and relapses.
A within-trial health economics study led by the Liverpool School of Tropical Medicine looked at patient and health system costs in detail and found that the 9-month all oral treatment is more expensive than the control regimen for the health system (largely driven by the cost of the regimen). However patient direct costs were lower in both study regimens compared to the control regimen.
TB on the rise again
The recently released WHO Global Tuberculosis Report 2022 highlights that an estimated 10.6 million people fell ill with TB worldwide in 2021 representing an increase of 4.5% from 2020 and reversing many years of slow decline. The estimated number of new cases of MDR-TB also increased by 3.1% during the same time period, with 450,000 new cases of rifampicin-resistant TB in 2021. And only about one-third of the MDR-TB patients are on treatment. Undoubtedly, the results of STREAM-2 study provide a new glimmer of hope for these patients.
We cannot lose new drugs to antimicrobial resistance
But resistance to the wonder drug Bedaquline has already emerged in South Africa, and one needs to tread carefully to not lose the efficacy of this wonder drug to antimicrobial resistance. As one study points out, the speed with which national programmes are implementing bedaquiline-based regimens is not matched with required pace of capacity building for rapid diagnostic tools for detecting drug resistance. The development of rapid molecular diagnostic methods that can detect resistance to at least all medicines from group A (that is, levofloxacin, moxifloxacin, bedaquiline, and linezolid) is urgently needed.
Dr Rusen cautioned that it is as important as ever to ensure patient-centred treatment approaches that maximize adherence as much as possible to help prevent the development of resistance. He said "While we are pleased with the performance of the regimens tested in STREAM and the evidence generated, there is still an urgent need to build upon these results and improve the efficacy and safety of MDR-TB regimens available."
Shobha Shukla - CNS (Citizen News Service)
(Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate. She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media). Follow her on Twitter @shobha1shukla or read her writings here www.bit.ly/ShobhaShukla)
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