Treatment completion for latent tuberculosis infection: a retrospective cohort study comparing 9\xa0months of isoniazid, 4\xa0months of rifampin and 3\xa0months of isoniazid and rifapentine

Adelaide H Mcclintock,Mckenna Eastment,Masahiro Narita,David R Park,Caroline L Pitney,Alexandra Molnar,Shireesha Dhanireddy,Christy M Mckinney

doi:10.1186/s12879-017-2245-8

Adelaide H Mcclintock, Mckenna Eastment + Show 6 more

Open Access

https://doi.org/10.1186/s12879-017-2245-8

Copy DOI

Abstract

BackgroundThe U.S. Centers for Disease Control and Prevention (CDC) recommended a new regimen for treatment of latent tuberculosis (three months of weekly isoniazid and rifapentine) in late 2011. While completion rates of this regimen were reported to be higher than nine months of isoniazid, little is known about the completion rates of three months of isoniazid and rifapentine compared to nine months of isoniazid or four months of rifampin in actual use scenarios.MethodsWe conducted a retrospective cohort study comparing treatment completion for latent tuberculosis (TB) infection in patients treated with nine months of isoniazid, three months of isoniazid and rifapentine or four months of rifampin in outpatient clinics and a public health TB clinic in Seattle, Washington. The primary outcome of treatment completion was defined as 270 doses of isoniazid within 12 months, 120 doses of rifampin within six months and 12 doses of isoniazid and rifapentine within four months.ResultsThree hundred ninety-three patients were included in the study. Patients were equally likely to complete three months of weekly isoniazid and rifapentine or four months of rifampin (85% completion rate of both regimens), as compared to 52% in the nine months of isoniazid group (p < 0.001). These associations remained statistically significant even after adjusting for clinic location and type of monitoring. Monitoring type (weekly versus monthly versus less often than monthly) had less impact on treatment completion than the type of treatment offered.ConclusionsPatients were equally as likely to complete the three months of isoniazid and rifapentine as four months of rifampin. Four months of rifampin is similar in efficacy compared to placebo as isoniazid and rifapentine but does not require directly observed therapy (DOT), and is less expensive compared to combination therapy with isoniazid and rifapentine, and thus can be the optimal treatment regimen to achieve the maximal efficacy in a community setting.

Highlights

IntroductionThe U.S Centers for Disease Control and Prevention (CDC) recommended a new regimen for treatment of latent tuberculosis (three months of weekly isoniazid and rifapentine) in late 2011
The U.S Centers for Disease Control and Prevention (CDC) recommended a new regimen for treatment of latent tuberculosis in late 2011
A total of 393 participants were included in the study: 87 patients received three months of isoniazid and rifapentine, 82 received four months of rifampin and 224 received nine months of isoniazid (Table 1)

Summary

Introduction

The U.S Centers for Disease Control and Prevention (CDC) recommended a new regimen for treatment of latent tuberculosis (three months of weekly isoniazid and rifapentine) in late 2011. Treating latent TB infection (LTBI) in high-risk individuals is one of the eight Millennium Development goals of the United Nations [1]. In the United States alone, 9,421 cases of active TB were reported in 2014 [2], and it is estimated that more than 13 million people have latent TB infection [3, 4]. Aggressive treatment of LTBI provides significant cost-savings and quality-adjusted life years saved because it dramatically reduces the risk of progression to active TB [5]. Most of the cases in the United States occur in foreign born individuals [6]. Primary care and Public Health clinics are often the first contact newly arrived patients have with the health care system for screening for TB infection

Methods

Results

Discussion

Conclusion