In March 2015 the STREAM Multi-Drug Resistant TB trial recruited its 400th participant, reaching its target number of people for this first part of the trial. The patients taking part in STREAM have been recruited from hospitals in Ethiopia, Mongolia, South Africa and Vietnam.
Multi-drug resistant TB, or MDR-TB, is disease that is resistant to at least two of the most widely used drugs in TB treatment (isoniazid and rifampicin). There are approximately half a million new cases of MDR-TB every year and it is a much more difficult to treat than drug-sensitive TB. The standard treatment time for drug-sensitive TB is 6 months. For MDR-TB, treatment can last 24 months or longer, with a success rate of no more than 50%. This makes treatment hard for both patients and the health system, so we urgently need to develop shorter and more effective treatments.
The first stage of the STREAM trial is assessing a 9-month regimen, which has shown promising results in a recent study in Bangladesh. This regimen is being compared with the standard, WHO recommended regimen of 20 or more months' duration.
The second stage of the STREAM trial will be testing two additional short course regimens for MDR-TB. One is a fully oral 9-month regimen (which, unlike the other regimens, will not require patients to have injections). The other is a 6-month regimen. Both of these regimens contain the newly-licensed drug bedaquiline. Additional sites from Asia, Europe and South America are expected to participate.