A study from Peru, between 1999 and 2002, demonstrated that more than 60 percent of XDR-TB patients not co-infected with HIV were cured after a personalized treatment.
Previous studied led by an international team of researchers had already shown that aggressive, outpatient treatment could cure multi-drug resistant tuberculosis (MDR-TB), which is resistant to two first-line anti-TB drugs.
In the present study, Peru researchers used a similar protocol for XDR-TB caused by bacteria that are resistant not only to the same first-line anti-TB drugs, but also to the two most important second-line drug classes.
A total of 810 patients with tuberculosis were referred for free individualized drug treatment and additional services as needed, including surgery, adverse-event management, and nutritional and psychological support.
Sputum culture and drug-susceptibility testing results, performed at the Massachusetts State Laboratory Institute in Boston, were available for 651 patients.
Based on susceptibility results for 12 anti-TB drugs, clinicians developed regimens that included five or more drugs to which the infecting strains were likely to respond.
Among the study participants, forty-eight patients had XDR-TB, 603 had MDR-TB and none of the XDR-TB patients were co-infected with the HIV virus.
The researchers found that 60.4 percent in the XDR-TB group and 66.3 percent in MDR-TB group were cured with the treatment.
However, the outcomes among XDR-TB patients were better than most reported from hospital settings in Europe, the U.S., and Korea.
"It's essential that the world know that XDR-TB is not a death sentence," says lead author Carole Mitnick, instructor in the Department of Global Health and Social Medicine at Harvard Medical School (HMS).
Patients with XDR-TB and other drug-resistant forms of the disease are often confined to hospitals for treatments but the new study showed that this treatment would not require hospitalization.
"As or even more importantly, our study shows that effective treatment does not require hospitalization or indefinite confinement of patients," Mitnick added.
The paper appears in The New England Journal of Medicine.