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MRC Clinical Trials Unit on World Tuberculosis Day 2012

14 March 2012

24 March 2012 marks annual World Tuberculosis Day, an event aimed at raising awareness of a disease that still affects one third of the world’s population, and is responsible for more deaths than any other infectious disease.

Research into tuberculosis (TB) forms an important part of the work of the CTU. Current trials aim to provide answers to questions that still exist around how best to treat people with TB, especially in areas of the world where drug resistance and HIV-infection add additional challenges to treatment.

TB is thought to be the world’s oldest infectious disease. Formally known in the UK as phthisis or consumption, TB was the single biggest cause of disease and death in the 19th century. Prior to the 1940s, there was no treatment for TB. A landmark clinical trial conducted by the MRC in London in 1946 demonstrated streptomycin to be the first effective treatment for TB and this led to a series of trials conducted in Africa and Asia resulting in a highly effective six-month combination regimen for the treatment of TB.

Today TB is responsible for more deaths than any other infectious disease. Every year around 8 million people are infected with active TB around the world, and 1.5 million people die from TB.

The slogan for World Tuberculosis Day 2012 is ‘Stop TB in my lifetime’. The MRC CTU continues to be involved in randomised controlled clinical trials to contribute towards this goal. These include:

Study C - This completed trial demonstrated that a 4-drug fixed-dose combination tablet was no less effective than separate drugs in treating tuberculosis. Fixed-dose combinations greatly reduce the number of tablets that a patient needs to take, making the treatment much easier to adhere to, resulting in better patient outcomes in the community.

RIFAQUIN - This ongoing trial aims to evaluate whether the addition of moxifloxacin and rifapentine can shorten treatment from 6 to 4 months or be given less frequently than daily without reducing treatment efficacy. Shorter and simpler regimens make the treatment much easier to adhere to, resulting in better patient outcomes in the community. Results are expected in early 2013.

REMOX TB - This ongoing trial aims to evaluate whether the addition of treatment can shorten treatment from 6 to 4 months. Results are expected in 2014.

STREAM - Multi-drug resistant TB (MDR-TB) is disease that is resistant to the two main treatments for TB and therefore is much harder to treat. Data from a series of observational studies in Bangladesh has suggested a new treatment regimen for MDR-TB of only 9 months duration could be more effective than the currently recommended treatment of 20-24 months duration. The STREAM trial aims to evaluate whether this 9 month regimen is no less effective or even more effective that the current standard of care. The first patients will be randomised in the STREAM study in the next few weeks.