Novartis in the fight against tuberculosis
World TB Day
World TB Day on March 24 will once again be marked by varied emotions: a mixture of pride at progress to date and concern at the continuing devastation wrought by a disease we once thought had been controlled.
The main goal of World TB Day is simple: to build public awareness that TB remains a lethal global epidemic, but it can be diagnosed and cured - and, one day, eliminated. Novartis is committed to helping achieve it.
Every 15 seconds, one person dies of tuberculosis (TB). The war against this deadly disease has been fought for well over a century, yet TB continues to claim nearly two million victims per year. As World TB Day on March 24 raises global awareness, Novartis remains a committed partner in the struggle.
TB is highly infectious and complex to treat, requiring a combination of drugs administered over six to eight months. A lack of patient compliance during this lengthy period has led to the emergence of multi-drug-resistant (MDR) TB, with more than 400 000 new cases of MDR TB reported every year.
In its strategy to help control TB, the Novartis Group:
- Provides effective, high-quality TB medications, sometimes at no cost
- Supports work on the ground to improve access to treatment for TB patients
- Conducts research aiming to discover new medicines against the lethal disease
Sandoz, the Group’s generic arm, supports patient compliance by providing global access to fixed-dose combinations (FDCs) of the four essential first-line anti-TB drugs that conform with WHO guidelines. Patients in more than 70 countries are receiving Sandoz TB medication. Sandoz also invested in a multicenter clinical trial comparing the efficacy of FDCs to individual drugs in treatment of TB. Results will be published later this year. The division also sponsors several projects, including the India-based Joint Efforts to Eradicate Tuberculosis (JEET), a combined effort among patients, the public and Sandoz to create awareness of TB and control spread of the disease.
Novartis has agreed to donate half a million TB treatments free of charge in cooperation with the global Stop TB Partnership initiative, aimed at reducing the burden of TB as a public health problem.
At this time, the Novartis Foundation for Sustainable Development (NFSD) works closely with the Tanzanian National Tuberculosis Program to improve patient access to treatment. NFSD has taken the WHO-recommended Directly Observed Therapy Short-course (DOTS) – an approach that requires TB patients to swallow their medicines under direct daily observation by a medical professional – one step further. The Patient-Centered TB Treatment (PCT) in Tanzania gives patients the choice to follow treatment either at a health facility or at home supervised by a family member.
Klaus Leisinger, President and CEO of the NFSD, says: “Our experience on the ground shows that the key to improving access is not just to make medicines available and affordable to poor patients, but also to improve healthcare services and to take equal account of the ‘demand side’ – for instance, whether people actually seek diagnosis and treatment in the first place.”
The challenges of TB
- TB bacterium is highly infectious, spreading through the air every time an infected person coughs, spits or sneezes. Growing numbers of HIV / AIDS sufferers also have TB – and often die within months if not treated.
- TB’s main victims are young people, often family “breadwinners.”
- Existing diagnostic tests are mostly inadequate, while new, more sensitive tests are expensive and require fresh infrastructure.
- While the currently used TB vaccine, BCG, is available for children in some countries, it offers only limited protection.
- TB is complex to treat, requiring a combination of drugs administered over six to eight months.
- Erratic and incomplete treatment regimes have led to the emergence of multi-drug-resistant (MDR) TB.
The PCT vastly improves convenience and patient compliance. “We like the approach very much,” says a 40-year-old male PCT recipient. “It helps us get more rest, pay less, and it helps us get time to sleep after taking the drugs.”
Researching new solutions
The Novartis Institute for Tropical Diseases (NITD) in Singapore plays a leading role in the search for new anti-TB drugs. The target profile of these new TB drugs will have to meet various criteria, including effectiveness against multi-drug-resistant TB, reduced treatment duration, oral bioavailability, temperature stability and low production cost. In collaboration with international partners, a team of approximately 50 scientists at NITD are dedicated to this task.
The scientific challenge in TB research reflects the phenomenal capacity of Mycobacterium tuberculosis, the cause of TB, to adopt a dormant state and hide in the body, impervious to drugs, for months, years or even decades. If a host’s immune system is weakened – from HIV, for example – those latent bugs suddenly come out of hiding and reactivate TB.
NITD has been tapped as the industry partner in the Grand Challenges in Global Health initiative launched by the Bill & Melinda Gates Foundation and the US Foundation for the National Institutes of Health. NITD will participate in a project, led by Professor Douglas Young of Imperial College London, aiming to discover drugs for treatment of dormant TB infection.