But the private sector has no easy access to the newer drugs as the public sector does,’’ he said. “One of the studies conducted at Hinduja Hospital showed that 70% of India’s patients preferred to take TB treatment in the private sector. Hence, both delamanid and bedaquiline are only available through the union health ministry. In India, however, health authorities said newer drugs such as bedaquiline and delamanid should not be available for direct sales at pharmacies as people would take them indiscriminately and bring about resistance. Mumbai is considered the world’s capital of drug-resistant TB, with approximately 5,000 new cases detected every year. Also, there is widespread abuse of antibiotics that further fuelled the resistance patterns. Over the years, the TB bacilli has grown stronger and resistant to these medicines and has led to the emergence of multi- and extremely drug-resistant strains.
In the past 50 years, there have been only 20 new medicines for tuberculosis patients. We have 16 compounds, nine novel compounds and nine novel targets in various stages of research,’’ he said. “At present, we are stuck with cure rates of 40%, 50% or 60%, but there is exciting research going on.
Newer regimens such as BPaL (bedaquiline, pretomanid, and linezolid) have cured 90% patients who have taken it, but it isn’t available in India so far. The reason for Dr Udwadia’s “change of heart” is the slew of new “promising medicines” in the pipeline.
Mumbai, however, gained in the bargain with the government-run RNTCP fast-tracking newer tests, regimen and funds for the city’s patients. “It created a bit of a controversy in 2012,’’ said the doctor while delivering an oration on tuberculosis on Sunday at JW Marriott, Sahar.
In 2012, the emergence of TDR cases kicked up a worldwide furore with the World Health Organization (WHO) flying in teams to check the extent of treatment-resistant TB cases in Mumbai. Need for more equitable access to TB treatments in India, says Dr Udwadia Mumbai: A decade after he coined the term “totally drug-resistant TB cases (TDR-TB)” for 12 patients in whom none of the known TB drugs worked, pulmonologist Dr Zarir Udwadia wishes he hadn’t used it at all.
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