Abstract
Despite recent success in reducing its incidence, tuberculosis remains a considerable challenge in Canada, particularly among foreign-born and Indigenous populations. A key component of the strategy for controlling the disease is the treatment of latent tuberculosis infection. The standard treatment consists of isoniazid (INH) daily for nine months. In recent years, shorter regimens have been developed in the hope of increasing rates of treatment acceptance and completion. Of these, the shortest and most recently developed is a combination of INH and rifapentine taken once weekly for 12 doses (3HP), typically using directly observed therapy (DOT). This regimen has been approved by the Food and Drug Administration in the United States but is not yet authorized in Canada. Based on a rapidly expanding number of observational studies and randomized controlled trials, 12 weeks of 3HP appears to have similar efficacy to nine months of INH, a favourable adverse event profile and potentially improved rates of treatment completion. Although rates of treatment acceptance, the role of self-administered therapy and the regimen's cost-effectiveness within the Canadian context remain uncertain, 3HP is a promising alternative to existing treatments for LTBI.
Highlights
The incidence of active tuberculosis (TB) in Canada has gradually declined over the past decade, the disease remains a major health challenge that disproportionately affects marginalized populations [1]
Rifapentine is not recommended for use in active TB in Canada [17]
Note that RMP/pyrazinamide is no longer recommended for latent tuberculosis infection (LTBI) treatment because of the increased risk of severe liver injury and death compared to INH [6]
Summary
The incidence of active tuberculosis (TB) in Canada has gradually declined over the past decade, the disease remains a major health challenge that disproportionately affects marginalized populations [1]. Based on a rapidly expanding number of observational studies and randomized controlled trials, 12 weeks of 3HP appears to have similar efficacy to nine months of INH, a favourable adverse event profile and potentially improved rates of treatment completion. A vital component of the overall approach to eliminating TB is reliable testing and effective treatment of latent tuberculosis infection (LTBI) to prevent active disease in at‐risk populations [3].
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