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Review confirms efficacy, safety of common latent TB treatments

Recent evidence confirms that the standard treatment regimens currently recommended by WHO and the CDC for latent tuberculosis infection are safe and effective for preventing active infection, according to a review published in Annals of Internal Medicine.

“Many treatment regimens for [latent tuberculosis infection] are available globally; five are recommended by [WHO], and four of these by the [CDC],” Dominik Zenner, MD, from the department of infection and population health at the University College London’s Institute for Global Health, and colleagues wrote. “Evidence on the efficacy of shorter regimens with a reduced pill burden is evolving, but more information on effectiveness is still urgently needed.”

To determine the efficacy and harms of latent TB infection treatment regimens aimed at preventing active TB, researchers performed a review of randomized control trials that assessed human latent TB therapies and reported at least hepatotoxicity and prevention of active TB. Zenner and colleagues reviewed information from databases PubMed, Embase and Web of Science from indexing to May 8, 2017, to extract data from eligible studies and assess study quality according to a standard protocol.

Analysis of 61 studies showed that several standard latent TB therapy regimens were safe and effective at preventing active TB compared with placebo. These regimens included isoniazid regimens of 6 months (OR = 0.65; 95% credible interval [CrI], 0.5-0.83) or 12 to 72 months (OR = 0.5; 95% CrI, 0.41-0.62), rifampicin-only regimens (OR = 0.41; 95% CrI, 0.19-0.85), rifampicin-isoniazid regimens of 3 to 4 months (OR = 0.53; 95% CrI, 0.36- 0.78), rifampicin-isoniazid-pyrazinamide regimens (OR = 0.35; 95% CrI, 0.19-0.61) and rifampicin-pyrazinamide regimens (OR = 0.53; 95% CrI, 0.33-0.84). Compared with no treatment, researchers found proof of efficacy for weekly rifapentine-isoniazid regimens (OR = 0.36; 95% CrI, 0.18-0.73).

“Despite limitations that include quality and reporting standards of the underlying studies, the evidence for safety and efficacy of most standard treatment regimens is robust,” Zenner and colleagues wrote. “More evidence is needed, particularly for [rifapentine]-based regimens; for the [isoniazid-rifampicin] combination; for alternative treatments with a shorter duration and lower pill burden; and to assess the effect of covariates, such as [antiretroviral therapy].” – by Savannah Demko

Disclosures: Zenner reports no relevant financial disclosures. Please see the full study for a complete list of all other authors’ relevant financial disclosures.