Early trends from India survey show TB drug resistance rates less than WHO estimates

Print 17 July 2015
EJ Lane / FeircePharmaAsia

Early trends from India's first survey on multidrug-resistant tuberculosis showed a lower rate of infections than World Health Organization estimates in findings that will help shape the government's treatment focus, the Indian Expressnewspaper reports.

The WHO had put overall incidence of MDR-TB around 12% in India.

But the Indian Express said a survey commissioned by India's Ministry of Health showed a bit more than 2% of new cases are resistant to some TB drugs, while as many as 9% are patients that underwent conventional treatment and subsequently infected by MDR-TB.

However, the newspaper said that interim results of the survey are still awaited, though the initial trends were discussed this week by ministry officials on the government's Revised National Tuberculosis Control Programme.

Concerns over multidrug-resistant tuberculosis, or MDR-TB, jibe with a wider threat of antibiotic-resistant bacteria globally linked to overuse and poor monitoring of patient compliance to the treatment regimes.

Tuberculosis, or TB, is the world's deadliest infectious disease after AIDS, according to the WHO, with strains that no longer respond to isoniazid and rifampicin, two standard therapies, of particular concern.

The survey covered 4,840 TB cases, with 3,061 of those new and 1,779 previously treated, the newspaper said.

A strong focus was placed on patients previously treated because they are more likely to spread the disease, the newspaper said.

"No survey had ever been done in India to actually find out the extent of drug resistance among TB patients," a source who attended the meeting told the Indian Express.

"That is why this survey was commissioned in September 2014. The interim results will be available sometime next year as enrollments are yet to be completed but initial trends show there is an incidence of 2.3% drug resistance in new TB patients and about 8-9% in those who had been previously treated. This is far less than the WHO projections."

Citing an official in the health ministry, the Indian Express said that WHO used figures from 2007 and 2015 under which more than 651,000 patients were tested for MDR-TB, with about 82,450 diagnosed positive--levels around 12%.

"These were WHO figures and not data from actual surveys," the official told the newspaper.

"They were extrapolated data from surveys and though we never believed this 12% figure the survey was commissioned under the impression that maybe the resistance incidence would be to the tune of 10% Initial indications that it may not touch 10% even in previously treated cases are very encouraging."

In Asia, Otsuka Pharmaceutical has recently applied to sell the MDR TB drug Delamanid in Indonesia and join hands with fellow Japanese firm Nipro to ramp up diagnostic efforts, the Nikkei Asian Review reports.

The drug has won approval from Japan's Pharmaceutical and Medical Devices Agency and in Europe is used under tight controls set by the European Medicines Agency.

But it is not approved in the U.S., where another treatment for multidrug-resistant tuberculosis, Sirturo, by Johnson & Johnson's ($JNJ) Janssen Therapeutics was the first new TB medicine approved of any kind for 40 years.

Johnson & Johnson and Otsuka do not expect to make money on the drugs.

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