India to see largest rollout of TB drugs this year
New Delhi, April 2017:
Seven years after the World Health Organisation (WHO) approved guidelines to treat tuberculosis in children, India will become the largest country globally to roll out the world's first easily-dissolvable and flavoured TB drugs.
The child-friendly tablets, which are a combination of two or more medicines in a fixed dose combination (FDC), have been recently introduced through the government's TB control programme in six states, and will now be launched privately and through government centres in the remaining states this year.
According to WHO, one million children contract TB every year, while it kills over 400 daily, across the globe. The child-friendly treatment could, therefore, prove to be a game-changer in simplifying and improving therapy. India has around 75,000 paediatric TB cases, and 17 lakh adult TB patients, as per government estimates.
"India will be the first country in the world to offer the largest number of kidfriendly FDCs, by year-end", said Dr Sunil Khaparde, DDG ministry of health and family welfare, and head central TB division.
"Improved diagnostics will also be made available through 1,300-odd GeneXpert machines, which will ensure one machine per 10 lakh population," he added. Although curable, TB treatment consists of multiple drugs taken for a minimum of six months. When treating children, it is difficult to approximate the correct dose by manually combining several drugs together. Moreover, splitting the pills results in a bitter taste as well as imprecise dosage.
Experts say most companies don't launch improved medication due to absence of "commercial" opportunity and "low margins". Domestic companies such as Macleods Pharmaceuticals and Lupin are leading players in supplying first-line TB medicines globally.
"We supplied paediatric drugs for 2 lakh children in 36 countries since December 2015. In 2017, a roll out will happen in both public and private space, and about 15,000 children will be treated from those supplies," said Vijay Agarwal, business development director of Macleods Pharmaceuticals.
"Timely diagnosis is the weakest link in India. In the public sector, TB remains undetected because doctors rely on old techniques like sputum smears, while empirical antibiotic therapies and nonspecific tests like X-rays in the private sector don't help in diagnosis.
While over 600 GeneXpert systems exist, they are not utilised to their full capacity," said Madhukar Pai, associate director, McGill International TB Centre, Canada.
At present, paediatric (multi-drug resistant) MDRTB is difficult to detect. "New diagnostics will enable clinicians to detect (drug resistant) DR-TB in children. Envisaging this, we have developed 10 dispersible products to treat MDR-TB in children. These drugs will be approved by WHO's pre-qualification of medicines programme in the next 1-2 years and will be launched worldwide, including India," Agarwal said.