Press Release - Aug 25, 2008

Research documents successful outcomes for patients with extensively drug resistant tuberculosis

Boston, MA – Rates of extensively drug-resistant tuberculosis (XDR-TB) are growing rapidly throughout the world, and curtailing the disease is a major World Health Organization (WHO) priority. Now, researchers from Brigham and Women’s Hospital (BWH) have shown successful treatment outcomes for patients with XDR-TB in Tomsk, Russia. These findings are published in the August 25, 2008 online issue of The Lancet.

"While early studies suggested that XDR-TB is untreatable, our report indicates that while it may be difficult, it is possible to treat these patients through the use of aggressive regimens," said Salmaan Keshavjee, MD, a researcher in the Division of Global Health Equity at BWH and lead author of the report. "A cure rate of 48.3 percent is promising in a disease that has been touted as untreatable."

Researchers report on the treatment approaches and outcomes of 608 patients with multi-drug resistant tuberculosis who were treated between September 2000 and November 2004 to determine the frequency of favorable outcomes and document clinical characteristics. Patients were categorized into two groups, those with XDR-TB and those with non-extensively drug-resistant (non-XDR) TB. Of the 608 patients, four percent or 29 patients were diagnosed with XDR-TB.

Researchers report:

* Drug resistant strains of TB are treatable. Of the 608 patients, 48.3 percent of patients with XDR-TB and 66.7 percent of patients with non-XDR-TB had treatment cure or completion.

* Prior, inadequate treatment of non-XDR-TB increases the chance for a patient to develop XDR-TB. Inadequate treatment includes an incorrect combination of medicines or inadequate duration of treatment.

* The frequency of adverse events did not differ in patients with XDR-TB as compared to patients with non-XDR-TB. This is the first report to provide information about the frequency of adverse events during a treatment course for XDR-TB specifically.

"Through aggressive management of XDR-TB cases, including by ensuring that patients are correctly diagnosed as early as possible and put on appropriate treatment for the correct length of time, it may be possible to slow the rise of XDR-TB deaths around the world and reduce further transmission of the most drug resistant strains of TB," said Keshavjee.

This research was funded by Bill & Melinda Gates Foundation, Eli Lilly Foundation, The Open Society Institute, Frank Hatch Fellowships in Global Health Equity at BWH, Infectious Disease Society of America, the Heiser Foundation, the United States National Institutes of Health, and the John D and Catherine T MacArthur Foundation.

Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org