scholarly journals 1410. Isoniazid Therapy for Latent Tuberculosis Infection in Patients with Cancer Treated with Checkpoint Inhibitors Immunotherapy

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S789-S789
Author(s):  
Alexandre Malek ◽  
Patrick Chaftari ◽  
Pablo C Okhuysen ◽  
Hiba Dagher ◽  
Harrys A Torres ◽  
...  
Keyword(s):  
Adverse Events ◽  
Cancer Patients ◽  
Latent Tuberculosis Infection ◽  
Panel Member ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
Cancer Center ◽  
Research Support ◽  
Significant Difference ◽  
Tuberculosis Reactivation

Abstract Background Data on the efficacy and tolerability of latent tuberculosis infection (LTBI) treatment in cancer patients receiving checkpoint inhibitor immunotherapy (CPI) is limited. We sought to assess LTBI therapy and its adverse events and outcomes in patients treated with CPI. Methods We performed a retrospective cohort study at MD Anderson Cancer Center of adult patients, between April 2016 and May 2021, who were receiving CPI and were diagnosed with LTBI based on positive T-SPOT TB test. We then compared those patients treated with isoniazid (INH) 5mg/kg daily versus those that did not receive INH therapy. Results We identified 35 patients treated with CPI who had a diagnosis of LTBI. Patients were divided into 2 groups: CPI alone (23 patients, 65.7%) and CPI+INH (12 patients, 34.3%). The majority of patients in both groups had renal cell carcinoma (34.3%) and melanoma (17.1%). Nivolumab as monotherapy was the most commonly used CPI agent in both groups (37.1%), whereas nivolumab and ipilimumab combination was mainly used in the CPI group (34.7%) compared to CPI+INH group (8.3%). In the CPI+INH group, 7 patients (58.3%) developed moderate to severe hepatoxicity that led to discontinuation of INH and CPI therapy versus none in the CPI group (p= 0.001). There was no statistically significant difference in the alanine aminotransferase (ALT) at baseline between both groups (p=0.117), whereas the median ALT level was significantly higher during CPI+INH therapy compared to CPI alone (135 U/L vs 24 U/L respectively, p=0.025. Furthermore, immune-related adverse events were reported in a total of 12 of 35 patients (34.2%). None of the patients in either group developed tuberculosis reactivation during a follow up period of up to 1148 days. Conclusion Our data suggest that latent tuberculosis reactivation is rare in cancer patients on CPI immunotherapy. Hepatotoxicity remains a concern in this patient population with LTBI treated with CPI and INH. With the widespread use of CPI, close laboratory and clinical monitoring is required to avoid life-threatening drug-induced liver injury and interruption of LTBI therapy and immunotherapy. Further clinical studies are warranted to determine the optimal management of LTBI during CPI therapy. Disclosures Pablo C. Okhuysen, MD, FACP, FIDSA, Deinove Pharmaceuticals (Grant/Research Support)Ferring Pharmaceuticals (Consultant)Melinta Therapeutics (Grant/Research Support)Merck & Co. (Grant/Research Support)Napo Pharmaceuticals (Consultant, Scientific Research Study Investigator, Research Grant or Support)Singulex (Consultant)Summit Therapeutics (Grant/Research Support) Dimitrios P. Kontoyiannis, MD, Astellas (Consultant)Cidara Therapeutics (Advisor or Review Panel member)Gilead Sciences (Consultant, Grant/Research Support, Other Financial or Material Support, Honoraria)

scholarly journals Latent Tuberculosis Infection (LTBI) Among Healthcare Workers (HCWs): 10 Years of Experience at Memorial Sloan Kettering Cancer Center (MSK)

2015 ◽  
Vol 2 (suppl_1) ◽  
Author(s):  
Esther Arguello Perez ◽  
Cynthia Eisenstein ◽  
William J. Schneider ◽  
Maria Del Castillo Garcia ◽  
Sherard N. J. Lacaille ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
Cancer Center ◽  
Years Of Experience

scholarly journals Short-course regimens of rifapentine plus isoniazid to treat latent tuberculosis infection in older Chinese patients: a randomised controlled study

2018 ◽  
Vol 52 (6) ◽  
pp. 1801470 ◽  
Author(s):  
Lei Gao ◽  
Haoran Zhang ◽  
Henan Xin ◽  
Jianmin Liu ◽  
Shouguo Pan ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
World Health ◽  
Controlled Study ◽  
Short Course ◽  
Significant Difference ◽  
Randomised Controlled ◽  
Active Disease

Latent tuberculosis infection (LTBI) management is now a critical component of the World Health Organization's End TB Strategy.In this randomised controlled trial (Chinese Clinical Trial Registry identifier ChiCTR-IOR-15007202), two short-course regimens with rifapentine plus isoniazid (a 3-month once-weekly regimen and a 2-month twice-weekly regimen) were initially designed to be evaluated for rural residents aged 50–69 years with LTBI in China.Due to the increasingly rapid growth and unexpected high frequency of adverse effects, the treatments were terminated early (after 8 weeks for the once-weekly regimen and after 6 weeks for the twice-weekly regimen). In the modified intention-to-treat analysis on the completed doses, the cumulative rate of active disease during 2 years of follow-up was 1.21% (14 out of 1155) in the untreated controls, 0.78% (10 out of 1284) in the group that received the 8-week once-weekly regimen and 0.46% (six out of 1299) in the group that received the 6-week twice-weekly regimen. The risk of active disease was decreased, with an adjusted hazard ratio of 0.63 (95% CI 0.27–1.43) and 0.41 (95% CI 0.15–1.09) for the treatments, respectively. No significant difference was found in the occurrence of hepatotoxicity (1.02% (13 out of 1279) versus 1.17% (15 out of 1279); p=0.704).The short regimens tested must be used with caution among the elderly because of the high rates of adverse effects. Further work is necessary to test the ultrashort regimens in younger people with LTBI.

A systematic review of adverse events of rifapentine and isoniazid compared to other treatments for latent tuberculosis infection

2018 ◽  
Vol 27 (6) ◽  
pp. 557-566 ◽  
Author(s):  
Christopher Pease ◽  
Brian Hutton ◽  
Fatemeh Yazdi ◽  
Dianna Wolfe ◽  
Candyce Hamel ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection

Adverse Events with 4 Months of Rifampin Therapy or 9 Months of Isoniazid Therapy for Latent Tuberculosis Infection

2008 ◽  
Vol 149 (10) ◽  
pp. 689 ◽  
Author(s):  
Dick Menzies ◽  
Richard Long ◽  
Anete Trajman ◽  
Marie-Jose Dion ◽  
Jae Yang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection

scholarly journals 795. Review of Treatment of Latent Tuberculosis Infection at VA Portland Healthcare System

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S286-S286
Author(s):  
Teena Xu ◽  
Graeme N Forrest
Keyword(s):  
Adverse Events ◽  
Latent Tuberculosis Infection ◽  
Skin Testing ◽  
Latent Tuberculosis ◽  
Treatment Completion ◽  
Completion Rate ◽  
Tuberculosis Infection ◽  
Tuberculin Skin Testing ◽  
Completion Rates ◽  
Directly Observed Therapy

Abstract Background Treatment of latent tuberculosis infection (LTBI) is important for tuberculosis elimination in low-incidence countries. Currently, the VA Portland Health Care System (VAPORHCS) offers both 3HP (12-dose rifapentine plus isoniazid directly observed therapy (DOT)) and 9H (9-month daily isoniazid) for treatment of LTBI. Majority of veterans are treated with 9H despite increasing evidence showing higher rates of completion with 3HP. We reviewed the rates of completion and adverse events (AE) between veterans treated with 3HP and 9H. Methods We performed a retrospective chart review on all patients within the VAPORHCS who initiated LTBI treatment with 9H or 3HP between January 2011 and December 2016. LTBI was diagnosed through tuberculin skin testing or interferon-γ release assay. 9H treatment was self administered while 3HP was under DOT. Collected data included demographics, co-morbid conditions, immunosuppression, treatment completion, and AE. Treatment completion was determined through chart documentation. Results A total of 93 patients were treated for LTBI. Most patients were white (71%) and male (86%). The median age was 57 years old. Seventy-two patients (77%) were treated with 9H, and 21 (23%) were treated with 3HP. The overall completion rate was 86%. Completion rates between 9H (91%) and 3HP (86%) were not significantly different (P = 0.46). Twenty-three patients (31.9%) on 9H and six patients (28.6%) on 3HP were on chronic immunosuppression with TNF inhibitors and/or corticosteroids (P = 0.78) with an overall completion rate of 86%. Nine patients (13%) on 9H and two patients (10%) on 3HP had HIV (P = 0.95). Overall rates of AEs were similar between the groups (4%, 14%, P = 0.11), including hepatotoxicity (2%, 0%, P = 0.57) and neurotoxicity (4%, 5%, P = 0.94). Conclusion The overall treatment completion rates were high and statistically similar between 9H and 3HP groups, even with immunosuppressive therapy. There were no significant differences in rates of adverse events. While the majority of patients were treated with 9H, these results suggest an opportunity for more use of the 3HP, possibly without the need for DOT regimen going forward. Disclosures All authors: No reported disclosures.

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