A “miracle drug” for XDR- Tb?
A drug known as Bedaquiline (BDQ) is being cited as the “only option” available to treat the cases of MDR Tb and XDR Tb, which are the more resistant versions of Tuberculosis disease.
Tuberculosis, abbreviated as Tb, is caused by a bacterium called as Mycobacterium Tuberculosis which spreads through air, when the patient infected with the bacteria coughs, sneezes, spits or speaks.
Further, it mostly affects a person’s lungs but it can affect other organs of the body as well. A person infected with the disease shows symptoms like chronic cough with blood-containing sputum, night sweats, fever and weight loss due to weakness.
Besides, not all Tb patients show symptoms when they are infected. It is estimated that as much as 10 % of patients have what is known as “latent Tb” which later progresses into active Tb.
Tb is one of the major causes of mortality in India and half of the patients end up losing their lives. Worse, it is now developing resistance to major drugs prescribed for its treatment. This is where terms like MDR Tb (Multi Drug Resistant Tuberculosis) and XDR Tb (Extensively Drug Resistant Tuberculosis) come into picture. In fact globally there have been cases of TDR Tb (Totally Drug Resistant Tuberculosis) as well where the patient’s body refuses all the drugs available for treating the disease.
Under this regard, the emergence of BDQ drug after five decades of research is a cause for hope for the patients and their families. A case has been filed in the Delhi High Court questioning the government over why it is denying the circulation of this drug throughout the country. It is thus, akin to denying Indian citizens the Right to Life enshrined under Article 21 of the Indian constitution.
Currently, it has been restricted to only few centres in the country. Moreover, it is prescribed to exceptional cases only and not every Tb patient.
The National Institute of Tuberculosis & Respiratory Diseases (NITRD) however feels that it is not the right time to fully launch this drug in the entire country. This is because its efficacy tests are far from complete and its adverse effects are not yet fully known. It may be possible that in case the patient develops drug resistance to this drug as well, then the complex strains evolved would spread in the community creating a catastrophe.
Already MDR, XDR and TDR varieties of Tb strains are circulating in the community. The resistance to this option too will be nothing but a huge disaster.
Further, in the field of medicinal research, efficacy and safety tests are a paramount concern and not simply a bureaucratic hurdle. These are such things which cannot be compromised for individual cases. Reports reveal that there have been few documented cases of Tb strains developing resistance to even BDQ elsewhere in the world.
It is pertinent to know that the drug is currently been used in more than 50 countries with some cases showing improvement.
But clearly more needs to be done in the case of India with its huge population density, high levels of illiteracy and lack of personal regimen and hygiene when it comes to long-lasting diseases like Tb whose treatment lasts for more than 6 months.
The need of the hour is to expedite the process of conducting thorough efficacy and safety tests of BDQ.
India needs to tread carefully on this front, and involve doctors in this exercise.