Thank you for downloading this presentation
This was part of a debate where the symposium considered
the proposal: “This house believes the 9-month
Bangladesh regimen should be the new standard of care
for MDR-TB treatment”
Dr Philipp du Cross kindly agreed to argue for the motion,
but this document should be considered with the caveat
that his views, and those of MSF, on the Bangladesh
regimen are more nuanced than what is presented in the
debate. Philipp was constrained by a confidentiality
agreement relating to some aspects of the data and we ask
you to consider this when viewing his presentation slides.
“This house believes the 9-month Bangladesh regimen
should be the new standard of care for MDR-TB treatment”
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Artwork Meek
Photo: m.a.r.c. from Berlin
https://commons.wikimedia.org/wiki/File:I_
Want_Change_Meek_street_art.jpg#file
Dr Philipp du Cros
Head of the Manson Unit, Médecins Sans Frontières UK
Those of us “lucky” enough to receive treatment
For many of us, the treatment makes us feel sicker
than the disease itself
TB and Me MDR TB
bloggers
http://blogs.msf.org
/en/patients/blogs/t
b-me
Global MDR TB Treatment Cascade
600,000
Loss to follow up =16%
Missing Outcome = 8%
(WHO 2012 cohorts)
500,000
400,000
300,000
200,000
100,000
0
Estimated new
cases
Estimated cases
amongst notified
cases
Notified
WHO, Global Tuberculosis Report 2015
Start Treatment
Adherent to
treatment
Success
Projected based on
2012 outcomes
Relapse free
Global MDR TB Treatment Cascade
600,000
Success = 50%
(WHO 2012 cohorts)
500,000
400,000
300,000
200,000
100,000
?
0
Estimated new
cases
Estimated cases
amongst notified
cases
Notified
WHO, Global Tuberculosis Report 2015
Start Treatment
Adherent to
treatment
Success
Projected based on
2012 outcomes
Relapse free
Toczek, Cox, du Cros, Cooke, Ford. Strategies for reducing treatment default in drug-resistant
tuberculosis: systematic review and meta-analysis. IJTLD 2013
The “Bangladesh” or “9-month” regimen
•Observational cohort analysis
•Bangladesh
•Damien foundation project
•427 MDR TB (incl 2 XDR)
•206 on Gfx-based regimen
9+ months
88% success rate
MDR-TB
Standard regimen 20-24 months
Short course regimen 9-11
months
Growing Evidence
•
•
•
•
Cameroon 89% (150 pts)
Niger
89.2% (65 pts)
Bangladesh 85.8% (476 pts)
Interim analysis 9 countries
80.9% (507 pts)
• MSF
– Uzbekistan 71.3% 129 pts
– Swaziland
– Small cohorts in South Sudan,
Somalia, DRC, India, Chad
•
•
•
•
•
? Fewer adverse events
Cheaper
Programmatically Easier
Reduce waiting lists
Low relapse
• What control group?
• Patient selection
The trouble with trials…………
• Duration
• Programme effectiveness
The Problem with Standards
Crisis Needs Bold Answers
The best is the enemy of the good
In Summary
The 9-month Bangladesh regimen
should be the new standard of care
What will you choose?