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Published on: August 16, 2021
Short-course isoniazid plus rifapentine directly observed therapy for latent tuberculosis in solid-organ transplant
Diego López de Castilla1, Robert M Rakita, Christopher E Spitters
11 Solid-Organ Transplant Infectious Disease Program, Division of Allergy and Infectious Disease, Department of Medicine, University of Washington, Seattle, WA. 2 TB Control Program, Public Health - Seattle & King County, WA. 3 Division of Pulmonary & Critical Care, Department of Medicine, University of Washington, Seattle, WA. 4 School of Pharmacy, University of Washington, Seattle, WA. 5 Address correspondence to: Ajit P. Limaye, M.D., University of Washington, Box 356174, 1959 NE Pacific St, Seattle, WA 98195-6174.
Background:
Short-course directly observed isoniazid plus rifapentine (INH/RPT) combination could have potential advantages over a standard 9-month INH regimen for the treatment of latent tuberculosis infection in solid-organ transplant (SOT) candidates.
Methods:
We prospectively assessed the safety and tolerability of 12 weeks of INH/RPT given directly observed therapy in 17 consecutive SOT candidates with latent tuberculosis infection.
Results:
The median age was 57 years and 82% were men. Of the 17 patients, 13 (76%) successfully completed therapy and 4 (24%) eventually underwent SOT. Treatment was prematurely discontinued in four patients. One of these patients underwent a kidney transplant. The overall dose compliance was 83% (169/204 scheduled doses), and 12 (71%) of 17 patients received 100% of scheduled doses. No patient developed transaminase elevations greater than twice baseline or greater than four times the upper limit of normal or clinical hepatotoxicity. No cases of TB developed during 20.4 months after transplant among INH/RPT-treated recipients.
Conclusions:
For carefully selected SOT candidates, combination INH/RPT weekly given as directly observed therapy seems to be reasonably well tolerated and is associated with a relatively high completion rate. Future larger prospective studies to confirm the safety and high completion rates reported here and to identify the most appropriate SOT candidates for this regimen are warranted.
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