New market dynamics needed for second-line TB drugs, say MSF and The Union

23 March 2011 - Paris - Médecins Sans Frontières (MSF) and the International Union against Tuberculosis and Lung Disease have released a report that provides a detailed overview of the market for drug-resistant tuberculosis (DR-TB) treatment.

The report, DR-TB drugs under the microscope, points to the limited availability and high cost of quality-assured second-line medicines. For many DR-TB medicines, the report says, the sustainability of drug supply is constantly under threat and therefore extremely vulnerable to disruption. "For some medicines, there is only one quality-assured source, while for others there may be several but they all rely on a single source of the active pharmaceutical ingredient required to make the drug," it states.

The report emphasizes that at present only a small percentage of people with drug-resistant TB are accessing high-quality drugs. And with only small numbers of patients on treatment, demand for DR-TB drugs is low, and the market for the development and production of DR-TB drugs remains unattractive.

This creates a vicious circle with limited drug supplies hindering the scale up of DR-TB treatment. As demand stays low, there is little incentive either for new producers to enter the market or for existing producers to invest in meeting WHO quality standards or increasing production capacity.

Low demand for DR-TB drugs is also caused by the difficulties surrounding diagnosis - only 11% of 440,000 new MDR-TB cases were detected in 2009, the report says. Until now, it has taken up to three months to determine a patient's precise drug-resistance profile, and diagnosis of TB is especially complicated in both people living with HIV/AIDS and children.

However, a new diagnostic tool based on molecular technology could help break the vicious circle by dramatically shortening the time it takes to determine whether someone has TB to 90 minutes. It can also determine whether a patient is resistant to one of the main first-line drugs to treat TB.

"If the new test is implemented more widely, improved diagnosis could contribute to the level of increased demand needed to make the DR-TB drug market more attractive to drug developers and manufacturers. This, in turn, could lead to additional suppliers entering the market and seeking WHO quality assurance, and prices decreasing," the report states, concluding that a number of targeted interventions are also needed to stimulate the MDR-TB drug market.

Read the full report