Is a 3-month regimen of isoniazid-rifapentine safe and effective for the treatment of latent tuberculosis infection in adults and children?

A regimen of isoniazid-rifapentine administered weekly for 12 weeks is similarly safe and effective as other regimens for preventing active tuberculosis (TB) disease in adults and children with latent TB infection—with significantly higher treatment completion rates (number needed to treat = 4.63). Isoniazid-rifapentine was administered by direct observation only in 13 of the 15 studies. (LOE = 1a-)

Njie GJ, Morris SB, Woodruff RY, Moro RN, Vernon AA, Borisov AS. Isoniazid-rifapentine for latent tuberculosis infection: A systematic review and meta-analysis. Am J Prev Med 2018;55(2):244-252.  [PMID:29910114]

Meta-analysis (other)

Government

Various (meta-analysis)

The standard treatment of latent TB with isoniazid for 6 months to 12 months is often difficult to accomplish because of low patient acceptance and low therapy completion rates. These investigators thoroughly searched multiple databases, including MEDLINE, EMBASE, Clinicaltrials.gov, and the Cochrane Library, as well as reference lists of pertinent articles, and they contacted subject matter experts, for studies evaluating an alternate 3-month isoniazid-rifapentine regimen. Eligible trials (N = 15) included English-only randomized trials and observational studies evaluating isoniazid-rifapentine as a treatment regimen for latent TB in patients 12 years or older, children aged 2 years to 11 years, or persons living with HIV/AIDS. Two reviewers independently assessed individual studies for inclusion and methodologic quality using standard criteria. Disagreements were resolved by consensus discussion. Approximately one-third of the trials had moderate to high risk of bias. In 13 of the 15 studies, isoniazid-rifapentine was administered weekly by direct observation only. A treatment regimen of isoniazid-rifapentine is similar to other latent TB infection regimens in its effectiveness to prevent active TB disease, but significantly more patients completed treatment with isoniazid-rifapentine compared with other regimens (87.5% vs 65.9%, respectively; number needed to treat = 4.63). There were no differences detected in the rates of severe adverse events, including death. No significant heterogeneity in the results was detected. The authors used 2 different methods for detecting publication bias: one found potential bias, the other did not.