Efforts on for shorter treatment regime to defeat TB in Pakistan

February 28, 2019

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Dr Amina Jindani gives a presentation on Wednesday.—White Star
Dr Amina Jindani gives a presentation on Wednesday.—White Star

KARACHI: Pakistan is set to become part of international efforts to develop a shorter treatment regime to defeat tuberculosis, currently the world’s largest infectious killer, claiming an estimated 4,900 lives daily.

The eight countries which account for 60 per cent of new TB cases are: India, Indonesia, China, Nigeria, Pakistan, South Africa, the Philippines and Bangladesh.

These points were raised during a lecture delivered by Dr Amina Jindani, honorary senior lecturer at St George’s University of London, held at the Aga Khan University (AKU) on Wednesday.

A leading specialist, Dr Jindani has been involved with clinical trials of tuberculosis since the 1960s, when she coordinated the first East African/British Medical Research Council trial of short-course chemotherapy in Africa.

The programme started with a presentation of the AKU team of infectious disease experts, highlighting their work on improved understanding of public health issues.

Dr Jindani has just embarked on the ‘Rifashort’ trial in which a safe four-month regime would be identified

Introducing Dr Jindani, Dr Bushra Jamil, a professor at the section of infectious diseases, department of medicine, said that the PhD thesis work of Dr Jindani based on the activity of TB drugs was so remarkable that it was now applied globally to evaluate new drugs being developed for the disease.

“Currently, Dr Jindani has just embarked on the ‘Rifashort’ trial in which a safe four-month regime would be identified. For this, she has been awarded a £2.5 million grant by the Medical Research Council’s Global Health Trials Scheme,” she told the audience.

Referring to her pivotal drug trials, Prof Jamil said that ‘RIFATOX’ trial showed that a high dose ‘rifampicin’ was safe and the ‘RIFAQUIN’ trial provided evidence for high efficacy of the drug if used once a week in the continuation phase.

On the clinical trials in Pakistan, she said that the Aga Khan University Hospital in Karachi and Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore (SKMCH&RC) would be participating in these trials apart from centres in other countries, including Botswana, Uganda, Guinea, Nepal, Peru and Mexico.

Giving a presentation on ‘The role of Rifamycins in the elimination of tuberculosis’, Dr Jindani spoke about the need for more trials and introducing a shorter treatment regime for TB.

In her opinion, the standard six-month regimen offered to patients with a combination of different medicines for drug-sensitive TB has remained unchanged for decades and has been inadequate to control the epidemic. Shorter, simpler regimens are urgently required to address the TB challenge.

She presented a series of slides showing results of previous trials with different drugs and suggested that the introduction of new, shorter treatment regimens could help reduce TB incidence and mortality that are expected under the current regimens.

“High dose ‘rifamycins’ (a group of antibiotics) offers best hope for reducing treatment duration in the foreseeable future. However, they have to be applicable to all cases, including those with HIV positive, diabetes, pregnancy, other co-morbidities,” she said while sharing results of some trials.

Explaining the need for more trials, she cited data, arguing that the disease was taking lives of 1,300,000 people annually.

“One death every 15 seconds from a curable disease. There is no effective vaccine in the near future while we see an increase in global population,” she said.

Answering a question, she said that 50 patients each would be enrolled from the AKUH and SKMCH&RC and the trial was likely to begin next month.

“We are waiting for approval from the Drug Regulatory Aut­hor­ity of Pakistan. All other approvals have been taken,” she said.

Published in Dawn, February 28th, 2019