Health-E: Strawberry flavours and excessive prices

One day, Phumeza Tisile woke up to a silent world. Her TV did not work and when she flushed the toilet, it was noiseless. The young student had gone deaf, thanks to huge doses of medicine she was forced to take to treat her multi-drug resistant TB. She had been taking 20 tablets and an injection every day in order to try to save her life, yet the disease stubbornly refused to react to the medication.

“Then one day, I met people from Médecins Sans Frontières (MSF) and they gave me linezolid and it worked. Eventually, after three years and three months, I was cured,” Tisile told the Union World Conference on Lung Health over the past weekend.

But the problem is that one single tablet of linezolid costs R655 in South Africa. “The global price for this product is about R76 per tablet but Sanofi is marketing it in South Africa at almost ten times that price,” according to the Treatment Action Campaign (TAC), which adds that Sanofi buys the drug cheaply from Indian generic producer, Hetero, then massively inflates the price.

International humanitarian organization, MSF buys the drug for its patients at about R110 per tablet. Although linezolid is registered for use in South Africa, and the Department of Health, has issued a tender to provide the drug in the public sector, the Department of Health has yet to purchase the drug. TAC says that this suggest companies set drug prices too high.

“Due to the cost, doctors must make a strong case for use in the public sector and many patients aren’t approved,” said TAC in a statement.

High cost, long treatment times and medicines with terrible side effects are the major problems associated with drug-resistant TB. Yet drug-resistance is growing and can be transmitted to anyone through coughing and sneezing. The standard treatment time for MDR TB is two years, including painful daily injections for at least six months. But a trial in Bangladesh, which has since been replicated in nine African countries, shows that a nine-month course with seven drugs is as effective as the longer regimen.

The trial, called STREAM, is now expanding to test another nine-month MDR-TB treatment regimen using bedaquiline, one of the few newer medicines for MDR TB produced by Janssen Pharmaceuticals. This trial, which has sites in South Africa, will test a nine-month regimen that does not require any injections, and an even shorter 6-month regimen.

“Among all the infectious diseases, MDR-TB has required one of the longest and most complex courses of treatment,” said Dr I.D. Rusen, Senior Vice President, Research and Development for The Union, which coordinated the study. “This shortened course of treatment could provide a powerful alternative for a country like South Africa, which is battling an ongoing epidemic of drug- resistant TB.”

Last week, Health Minister Aaron Motsoaledi lamented that it would take the world 180 years to eliminate TB at the slow rate of progress we are currently making – a mere 1,5 percent a year. But there were a number of positive signs of progress at the Union World Conference on Lung Health, which ended yesterday in Cape Town, that show the disease is finally being taken more seriously by governments, scientists and pharmaceutical companies. Last week, the TB Alliance launched the world’s first combination TB treatment for kids. More than 30,000 children develop tuberculosis (TB) each year in South Africa. Until now, their treatment has been six months of daily, bitter pills made for adults more than twice their size.

The world’s first combination TB treatments made especially for children combine the most commonly used TB drugs, rifampicin and isoniazid. A second new combination drug pairs the two staple TB drugs with a third TB drug, pyrazinamide. At just about R220 per six-month course, the new formulations can dissolve in water and come in strawberry or raspberry flavours. They also ensure that children will receive the proper drug doses – something that is not guaranteed when parents are forced to crush adult tablets into kid-sized powder.

Monique Davids will be thankful for this development. After her three-year-old daughter and two-month-old son developed TB at the same time as her husband, Davids spent her days shuttling between the hospital and home – trying to get two very sick but very resistant young children to take their treatment. For Davids, it meant taking up to seven adult-sized tablets and crushing them into powder she mixed with everything from formula to juice in an effort to get her children to take the life-saving treatment.

When her oldest child refused to take the treatment, “I told her that if she didn’t take the treatment, the police would come from her,” Davids said. “It was very traumatic for me because I’d never lied to her before.”

According to Davids, many parents in her community give up the hard fight to get medicine down kids’ throat with deadly results.

The alliance has promised that it will register and license the kids’ combination drugs for use in South Africa soon.

TB Alliance researchers are also currently working on a kid-friendly version of the TB drug isoniazid, which can also be used to prevent the development of active TB as well as a paediatric formulation of the drug bedaquiline, which treats drug-resistant TB. The first new drug in about 50 years, bedaquiline had been rolled out to about 150 patients with extensively drug-resistant (XDR) TB in South Africa as of June. The country is set to spend about R130million to roll out bedaquiline to at least 9,000 patients over the next three years, according to Dr Norbert Ndjeka, head of the Department of Health’s division on HIV, TB and drug-resistant TB. DM

Photo: A box of Pyrazinamide.