Tuberculosis Treatment Comparisons

Tuberculosis Treatment Comparisons

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.

Summary:

‘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.

Comment:

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′

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