Benefits Seen From New TB Drug

For the first time in 30 years physicians have a new drug for TB treatment, greatly simplifying patient care and reducing treatment costs. The new drug, rifapentine, when taken in combination once a week with the old medicine isoniazid, cures TB patients as effectively and quickly as current standard therapies involving four or five drugs, taken two or even three times a week.

The findings are the result of treatment of 1,000 patients in 23 clinics in the United States and Canada. Three of the clinical collaborators are Harlem Hospital, Columbia University's School of Public Health and New York University School of Medicine/Bellevue. The results appeared in this week's issue of the Lancet ("Rifapentine and Isoniazid Once a Week Versus Rifampicin and Isoniazid Twice a Week for Treatment of Drug-Susceptible Pulmonary Tuberculosis in HIV-negative Patients: A Randomised Clinical Trial," August 17, 2002; 360: 528-34).

"It's a major advance," said Dr. Wafaa El-Sadr, chief of infectious disease at Harlem Hospital. "It can make patients' lives much easier." When treatment is easier, patients are far more likely to complete the many months of treatment necessary not only to cure them but also to render them noninfectious.

El-Sadi's patients are the most challenging. "About 40 percent of them are HIV-positive," she said. "If you ask, 'Have you ever been homeless?' about a third have. Unemployment is very, very high -- about 70 percent. Increasingly the patients are foreign-born, mostly from western Africa. And when you look at substance abuse, both drugs and alcohol, it's about 40 percent."

The new protocol means some TB patients need only come in once a week, which substantially reduces the hassles and the costs of clinical staffing, medication and other services, said Dr. Andrew Vernon of the CDC, co-chair of the large study. According to Vernon, the key to the breakthrough has been the longer half-life of rifapentine (trade name Priftin), which takes five times longer to break down in the body than its antecedent rifampin. One dose of the new drug carries a patient through an entire week.

There are limitations to the new treatment, however, which Vernon thinks will restrict its use to wealthy countries. The approach is not effective if the patient has HIV infection, a chest X-ray that shows large levels of pulmonary infection, or drug-resistant TB bacteria.

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