Evaluation of 3 Months of Once-Weekly Rifapentine and Isoniazid for Latent Tuberculosis Infection

2019 ◽  
Vol 54 (5) ◽  
pp. 457-463
Author(s):  
Ramara E. Walker ◽  
Stephanie Bass ◽  
Pavithra Srinivas ◽  
Cyndee Miranda ◽  
Lucileia Johnson ◽  
...  
Keyword(s):  
Latent Tuberculosis Infection ◽  
Cleveland Clinic ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
High Rate ◽  
Completion Rates ◽  
Directly Observed Therapy ◽  
Ltbi Treatment ◽  
Control And Prevention ◽  
Low Incidence

Background: Centers for Disease Control and Prevention recommends 3 months of once-weekly rifapentine/isoniazid (3HP) for latent tuberculosis infection (LTBI) treatment given by directly observed therapy (DOT) or self-administered therapy (SAT) in patients ≥2 years old. 3HP has been associated with increased incidence of hepatic, gastrointestinal, flu-like, and cutaneous adverse drug reactions (ADRs) compared with isoniazid monotherapy. Objective: This study evaluated 3HP completion rates and tolerability for LTBI treatment in a real-world setting. Methods: A single-center retrospective cohort with a nested case-control study, comparing patients experiencing ADRs with those who did not, evaluated patients ≥18 years old receiving 3HP by DOT or SAT for LTBI at Cleveland Clinic from October 2011 through July 2018. Information on baseline characteristics, 3HP administrations, and ADRs were collected. Results: Of 199 patients screened, 144 were included (111 DOT, 33 SAT). 3HP completion rates were high at 82.6% and similar between DOT and SAT groups. During treatment, 92/144 (63.9%) patients experienced any ADR. The most common ADR included flu-like symptoms (38.2%) and gastrointestinal (31.9%) and hepatic (2.1%) reactions. Despite high rate of overall ADRs, rates of significant ADRs (grade 2 or higher) were 4.2%. Overall, 9% of patients discontinued 3HP because of ADRs. After adjusting for other factors associated with ADRs at baseline, SAT was not associated with increased incidence of ADRs, but female sex was a significant predictor (odds ratio = 2.61 [95% CI, 1.23 to 5.56]). Conclusion and Relevance: This study observed high 3HP treatment completion rates, low incidence of significant ADRs, and low discontinuation rates resulting from ADRs.

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.

scholarly journals Factors Associated with Noncompletion of Latent Tuberculosis Infection Treatment in an Inner-City Population in Edmonton, Alberta

2014 ◽  
Vol 25 (5) ◽  
pp. 281-284 ◽  
Author(s):  
Kathy Malejczyk ◽  
Jennifer Gratrix ◽  
Avril Beckon ◽  
Danusia Moreau ◽  
Gwenna Williams ◽  
...  
Keyword(s):  
Inner City ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Retrospective Chart Review ◽  
Treatment Completion ◽  
Tuberculosis Infection ◽  
Completion Rates ◽  
Ltbi Treatment ◽  
Infection Treatment ◽  
City Population

A limited number of studies have been published that examine treatment completion rates and interventions used to increase treatment completion within an inner-city population. The purpose of the present study was to determine the rate of latent tuberculosis infection (LTBI) treatment completion in an inner-city population in Edmonton, Alberta, and to identify factors that correlated with treatment completion. A retrospective chart review was conducted involving patients who started LTBI treatment between January 1, 2005 and December 31, 2010 in Edmonton’s inner city. A total of 77 patients started treatment and 57 (74%) patients completed LTBI treatment. Homelessness was the only variable that was significantly associated with incomplete treatment (OR 8.0 [95% CI 1.4 to 45.6]) and it remained significant when controlling for drug use (adjusted OR 6.5 [95% CI 1.1 to 38.8]). While the present study demonstrated treatment completion rates comparable with or better than those described in the general population, it highlighted the need for continued emphasis on interventions aimed at improving outcomes within homeless populations.

scholarly journals Initiation and completion rates for latent tuberculosis infection treatment: a systematic review

2016 ◽  
Vol 16 (1) ◽  
Author(s):  
Andreas Sandgren ◽  
Marije Vonk Noordegraaf-Schouten ◽  
Femke van Kessel ◽  
Anke Stuurman ◽  
Anouk Oordt-Speets ◽  
...  
Keyword(s):  
Systematic Review ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
Completion Rates ◽  
Infection Treatment

scholarly journals Safety & Benefits of Directly Observed Therapy with Rifapentine and Isoniazid for Latent Tuberculosis Infection – Less is More?

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S621-S622
Author(s):  
Lawrence Ha ◽  
Megan Lam ◽  
Negin Niknam ◽  
Rebecca Schwartz ◽  
Rehana Rasul ◽  
...  
Keyword(s):  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
Directly Observed Therapy ◽  
Less Is More

Benefit of treatment of latent tuberculosis infection in individual patients

2015 ◽  
Vol 46 (5) ◽  
pp. 1397-1406 ◽  
Author(s):  
Claudia C. Dobler ◽  
Andrew Martin ◽  
Guy B. Marks
Keyword(s):  
Decision Aid ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
Quality Adjusted Life Years ◽  
Net Benefit ◽  
Ltbi Treatment ◽  
Life Years ◽  
Numbers Needed To Treat ◽  
Quality Adjusted Life

We aimed to develop a decision aid that estimates whether treatment of latent tuberculosis infection (LTBI) is likely to have a net gain in quality-adjusted life-years for an individual.A Markov model was developed which incorporated personalised estimates for risk of tuberculosis (TB) reactivation, TB death, quality-of-life impairments and treatment side-effects. The net effect of LTBI treatment was quantified in terms of quality-adjusted life-years gained or lost. Analyses were conducted for a representative set of hypothetical patients.LTBI treatment was estimated to be beneficial when the annual risk of TB reactivation exceeded 13/100 000 to 93/100 000 for females aged 10–75 years and 15/100 000 to 119/100 000 for males aged 10–75 years; the numbers needed to treat to avoid one case of TB were 93, 77, 85 and 72, respectively, at these threshold levels.LTBI treatment was estimated to confer a positive net benefit across a broad range of patients with characteristics typically seen in a low incidence setting for TB. Use of the decision aid has the potential to facilitate and increase confidence with LTBI treatment decisions by providing clinicians and patients with personalised estimates of likely net benefit.

scholarly journals Use of Video Directly Observed Therapy for Treatment of Latent Tuberculosis Infection — Johnson County, Kansas, 2015

2017 ◽  
Vol 66 (14) ◽  
pp. 387-389 ◽  
Author(s):  
Elizabeth Lawlor Holzschuh ◽  
Stacie Province ◽  
Krystle Johnson ◽  
Caitlin Walls ◽  
Cathy Shemwell ◽  
...  
Keyword(s):  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
Directly Observed Therapy ◽  
Johnson County

scholarly journals The Dynamic Change of Immune Checkpoints and CD14+ Monocytes in Latent Tuberculosis Infection

Biomedicines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1479
Author(s):  
Ping-Huai Wang ◽  
Ming-Fang Wu ◽  
Chi-Yu Hsu ◽  
Shu-Yung Lin ◽  
Ya-Nan Chang ◽  
...  
Keyword(s):  
Mononuclear Cells ◽  
Latent Tuberculosis Infection ◽  
Dynamic Change ◽  
Latent Tuberculosis ◽  
Immune Defense ◽  
Tuberculosis Infection ◽  
Immune Checkpoints ◽  
Peripheral Blood Mononuclear ◽  
Ltbi Treatment ◽  
Ltbi Group

Controlling latent tuberculosis infection (LTBI) is important for preventing tuberculosis (TB). However, the immune regulation of LTBI remains uncertain. Immune checkpoints and CD14+ monocytes are pivotal for immune defense but have been scarcely studied in LTBI. We prospectively enrolled participants with LTBI and controls from January 2017 to December 2019. We measured their CD14+ monocytes and the expression of immune checkpoints, including programmed death-1 (PD-1), cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), and T cell immunoglobulin mucin domain-containing-3 (TIM3) on T lymphocytes in peripheral blood mononuclear cells before and after LTBI treatment. A total of 87 subjects were enrolled, including 29 IGRA-negative healthy controls (HC), 58 in the LTBI group (19 without chronic kidney disease (non-CKD), and 39 with end-stage renal disease (ESRD)). All PD-1, CTLA-4, and TIM3 on lymphocytes and monocytes were higher in the LTBI group than that in the HC group. Total CD14+ monocytes were higher and PD-L2+CD14+ over monocytes were lower in patients with LTBI-non-CKD than that in the HC group. After LTBI treatment, CD14+ monocytes, TIM3+ on CD4+ and monocytes, and CTLA-4 on lymphocytes decreased significantly. Multivariable logistic regression indicated that CD14+ monocytes was an independent factor for LTBI-non-CKD from the HC group, whereas PD-L2+CD14+ monocytes and TIM3+ monocytes were significant for LTBI-ESRD from the HC group. In conclusion, LTBI status was associated with increasing CD14+ monocytes plus low PD-L2 expression. By contrast, increased expression of immune checkpoints over all immune cells might be due to Mycobacterium tuberculosis related immune exhaustion, which decreased after treatment.

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