Three-month weekly rifapentine plus isoniazid for tuberculosis preventive treatment: a systematic review

Area of Science:

• Public Health
• Infectious Diseases
• Pharmacology

Background:

• Tuberculosis (TB) preventive treatment uptake is suboptimal.
• The 3-month rifapentine plus isoniazid (3HP) regimen offers a potential solution for improved TB preventive therapy scale-up.
• This systematic review compares 3HP to standard daily isoniazid monotherapy (6- or 9-month regimens).

Purpose of the Study:

• To systematically review and assess the efficacy and safety of the 3-month rifapentine plus isoniazid (3HP) regimen compared to daily 6- or 9-month isoniazid monotherapy for tuberculosis prevention.
• To evaluate the impact of 3HP on active TB risk, hepatotoxicity, and treatment completion rates across different populations.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) identified through comprehensive database searches (PubMed, Embase, Web of Science, Cochrane), trial registers, and conference abstracts up to January 2017.
• Data pooling using a random-effects model where feasible.
• Inclusion of four studies comparing 3HP with daily 6/9-month isoniazid (6/9H) in adults with and without HIV co-infection, and in children/adolescents.

Main Results:

• No significant difference in the risk of active TB between 3HP and 6/9H regimens across adult and pediatric populations.
• Significantly lower risk of hepatotoxicity observed with the 3HP regimen in both HIV-co-infected and HIV-negative adults.
• Higher treatment completion rates were associated with the 3HP regimen across all studied subgroups.

Conclusions:

• The 3HP regimen demonstrates comparable preventive efficacy to isoniazid monotherapy.
• 3HP offers a favorable safety profile with reduced adverse events (hepatotoxicity) and improved treatment adherence.
• The 3HP regimen is a viable and effective strategy to significantly enhance the scale-up of tuberculosis preventive treatment programs.