Nurses will be interested to read the following article which is contained in Issue 25 -2017 of Infectious Diseases Research Review titled Self-administered versus directly observed once-weekly isoniazid and rifapentine treatment of latent tuberculosis infection: A randomized trial Authors: Belknap R et al.
‘This multinational (US, Spain, Hong Kong, South Africa) open-label, randomised, phase IV non-inferiority trial (15% margin), compared once-weekly isoniazid and rifapentine by self-administration (with monthly monitoring or weekly text message reminders and monthly monitoring) versus direct observation in 1002 patients (median age 36 years, 48% women, 77% US based) with latent TB infection.
Overall, treatment completion (≥11 doses in 16 weeks) was 87.2% (95% CI 83.1-90.5) for direct-observation versus 74.0% (95% CI 68.9-78.6) for self-administration and 76.4% (95% CI 71.3-80.8) for self-administration with reminders.The treatment completion rates in theUS were 85.4% (95% CI 80.4-89.4) versus 77.9% (95% CI 72.7-82.6) and 76.7% (95% CI 70.9-81.7). Only in the US did self-administration without reminders meet non-inferiority criteria when compared to direct observation.
The PREVENT study demonstrated that 3 months of directly observed therapy was safe and effective with a higher treatment completion rate than 9 months of daily isoniazid by self-administered therapy. In this large (n = 1002), multisite, open-label, randomised study (iAdhere), once-weekly isoniazid and rifapentine by self-administered therapy with or without text message reminders was non-inferior to directly observed therapy at sites in the US. Excluding South Africa, treatment completion was higher than reported with 9 months of isoniazid.
Adverse events were similar in the directly observed therapy and self-administered therapy groups and similar to those reported previously. The major study limitation was the low completion rate in the self-administered therapy group in South Africa. Adolescents and children were not enrolled in the iAdhere study, and self-administered therapy in this group requires further evaluation. Self-administered once-weekly isoniazid and rifapentine with monthly monitoring is a promising alternative strategy for treatment of latent tuberculosis infection.
Reference: Ann Intern Med. 2017;167(10):689-97′
Research Review Australia provides clinical research updates. Covering top 10 research studies with commentary by well-known Australian experts. They are a great tool to help nurses keep up to date. Reviews are sent by email and cost nothing to subscribe. Subscribe online at www.researchreview.com.au or send an email to Trish (our database administrator) [email protected]”