Isoniazid-Rifapentine for Latent Tuberculosis Infection: A Systematic Review and Meta-analysis

Area of Science:

• Public Health
• Infectious Diseases
• Pharmacology

Background:

• Latent tuberculosis infection (LTBI) treatment is crucial for tuberculosis elimination in the U.S.
• The CDC recommends a short-course 3-month isoniazid-rifapentine regimen.
• Longer LTBI treatment regimens are currently more widely prescribed despite recommendations.

Purpose of the Study:

• To review current evidence on the effectiveness, safety, and treatment completion of the 3-month isoniazid-rifapentine regimen.
• To compare the 3-month regimen with other LTBI treatment regimens, primarily 9-month isoniazid.
• To identify factors limiting the adoption of the 3-month regimen.

Main Methods:

• A systematic review using Community Guide methodology was conducted.
• Evidence published between January 2006 and June 2017 was identified, evaluated, and summarized.
• Data analysis was completed in 2017, including 15 unique studies.

Main Results:

• The 3-month isoniazid-rifapentine regimen demonstrated equal effectiveness compared to other LTBI regimens (OR=0.89, 95% CI=0.46, 1.70).
• Treatment completion rates were significantly higher for the 3-month regimen (87.5%) versus others (65.9%).
• Adverse events, treatment discontinuation due to adverse events, and death rates were similar across regimens.

Conclusions:

• The 3-month isoniazid-rifapentine regimen is a safe and effective alternative for LTBI treatment.
• This short-course regimen offers superior treatment completion rates compared to longer regimens.
• Findings support the wider adoption of the 3-month regimen in LTBI management strategies.