Disparities in treatment of multidrug-resistant tuberculosis across Europe
Scientists have shown that multidrug-resistant tuberculosis care in Eastern Europe is markedly worse than in Western Europe.
The global increase of tuberculosis patients is alarming, particularly the increase of cases of so-called multidrug-resistant tuberculosis (MDR-TB) in which the pathogen is insensitive to the most effective drugs. According to the World Health Organisation (WHO), the number of patients diagnosed with MDR-TB has been increasing by an average of 20 percent per year over the last 5 years. The WHO reports that on an international level, the chances of successful MDR-TB treatment are only around 50 percent.
For over a decade, doctors and researchers from the “Tuberculosis Network European Trialsgroup” (TBNET) have dedicated themselves to the causes of these poor MDR-TB treatment results in Europe. TBNET is led by the Research Center Borstel – Leibniz Lungenzentrum, which is a member establishment of the German Center of Infection Research (DZIF). In a current study (Günther G et al. Am J Respir Crit Care Med 2018), researchers have been able to show for the first time that substantial differences of MDR-TB patient care exist within Europe.
In so-called high-incidence countries in Eastern Europe such as Belarus and Moldavia, very many patients have MDR-TB. However, in these countries, patients have two-month longer waiting times for treatment that in Western Europe. While treatment in Western Europe is generally tailored to individual results derived from antibiotic resistance tests, patients in Moldavia and Belarus are frequently administered set standard treatment with some of the drugs already being ineffective. Additionally, standard treatment results in a four-fold higher development of new, additional antibiotic resistance than individually tailored treatment that has already taken into account an existing resistance profile. The risk of dying from MDR-TB is 5 times higher in East European high incidence countries compared to Western Europe.
Chances of cure are better than expected
However, this study had a surprise in store: data assessment showed that the chances of cure for East European MDR-TB patients from high incidence countries seemed to be four times higher than for West European patients. “This is solely due to the definition of cure used by the WHO,” explains Professor Christoph Lange, from the Research Center Borstel and head of the TBNET study. “The WHO uses criteria to define MDR-TB cure, which are obtained from the last day of treatment. This is comparable to saying to a cancer patient that he/she is cured on the last day of chemotherapy without considering the risk of a relapse,” says Lange. Together with Dr Gunar Günther from the Research Center Borstel and colleagues from 23 hospitals across 16 European countries, Prof Lange observed the courses of treatment of 380 patients with MDR-TB starting from the day of diagnosis through to one year after the end of treatment. Subsequently, the scientists formulated new definitions for treatment results and were able to show that the actual chances of being cured from MDR-TB in Europe are considerably higher than previously assumed. Nonetheless, treatment does fail in 25 percent of patients in East Europe, and in only 15 percent of patients in West Europe. “In Europe, major differences in tuberculosis patient care exist, with the most affected countries having the fewest resources for prevention, diagnostics and treatment,” says Lange. “Here we have a concrete need for action to help our European neighbours.”
Individualised treatment increases the chances of cure
MDR-TB can actually be treated well with modern drugs and resources. Clinical researchers from the DZIF research field “Tuberculosis” have recently been able to show that under individualised treatment, the chances of cure for MDR-TB patients are currently no different to those for patients with non-multidrug-resistant tuberculosis. (Heyckendorf J et al. Eur Respir J 2018).
