scholarly journals Treatment with isoniazid or rifampin for latent tuberculosis infection: population-based study of hepatotoxicity, completion and costs

2020 ◽  
Vol 55 (3) ◽  
pp. 1902048 ◽  
Author(s):  
Lisa A. Ronald ◽  
J. Mark FitzGerald ◽  
Gillian Bartlett-Esquilant ◽  
Kevin Schwartzman ◽  
Andrea Benedetti ◽  
...  
Keyword(s):  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Treatment Completion ◽  
Population Based ◽  
Direct Costs ◽  
Tuberculosis Infection ◽  
Cost Ratio ◽  
Liver Transplants ◽  
Health Administrative Data ◽  
Severe Hepatotoxicity

Clinical trials suggest less hepatotoxicity and better adherence with 4 months rifampin (4R) versus 9 months isoniazid (9H) for treating latent tuberculosis infection (LTBI). Our objectives were to compare frequencies of severe hepatic adverse events and treatment completion, and direct health system costs of LTBI regimens 4R and 9H, in the general population of the province of Quebec, Canada, using provincial health administrative data.Our retrospective cohort included all patients starting rifampin or isoniazid regimens between 2003 and 2007. We estimated hepatotoxicity from hospitalisation records, treatment completion from community pharmacy records and direct costs from billing records and fee schedules. We compared rifampin to isoniazid using logistic (hepatotoxicity), log-binomial (completion), and gamma (costs) regression, with adjustment for age, co-morbidities and other confounders.10 559 individuals started LTBI treatment (9684 isoniazid; 875 rifampin). Rifampin patients were older with more baseline co-morbidities. Severe hepatotoxicity risk was higher with isoniazid (n=15) than rifampin (n=1), adjusted OR=2.3 (95% CI: 0.3–16.1); there were two liver transplants and one death with isoniazid and none with rifampin. Overall, patients without co-morbidities had lower hepatotoxicity risk (0.1% versus 1.0%). 4R completion (53.5%) was higher than 9H (36.9%), adjusted RR=1.5 (95% CI: 1.3–1.7). Mean costs per patient were lower for rifampin than isoniazid: adjusted cost ratio=0.7 (95% CI: 0.5–0.9).Risk of severe hepatotoxicity and direct costs were lower, and completion was higher, for 4R than 9H, after adjustment for age and co-morbidities. Severe hepatotoxicity resulted in death or liver transplant in three patients receiving 9H, compared with no patients receiving 4R.

scholarly journals Use of a scoring strategy to determine clinical risk of progression and risk group-specific treatment adherence in subjects with latent tuberculosis infection

2017 ◽  
Author(s):  
Michael Scolarici ◽  
Ken Dekitani ◽  
Ling Chen ◽  
Marcia Sokol-Anderson ◽  
Daniel F Hoft ◽  
...  
Keyword(s):  
High Risk ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Standard Of Care ◽  
Treatment Completion ◽  
Risk Groups ◽  
Tuberculosis Infection ◽  
Current Standard ◽  
Clinical Risk ◽  
The Us

ABSTRACTBackgroundAnnual incidence of active tuberculosis (TB) cases has plateaued in the US from 2013-2015. Most cases are from reactivation of latent tuberculosis infection (LTBI). A likely contributor is suboptimal LTBI treatment completion rates in subjects at high risk of developing active TB. It is unknown whether these patients are adequately identified and treated under current standard of care.MethodsIn this study, we sought to retrospectively assess the utility of an online risk calculator (tstin3d.com) in determining probability of LTBI and defining the characteristics and treatment outcomes of Low: 0-<10%, Intermediate: 10-<50% and High: 50-100% risk groups of asymptomatic subjects with LTBI seen between 2010-2015.Results51(41%), 46 (37%) and 28 (22%) subjects were in Low, Intermediate and High risk groups respectively. Tstin3d.com was useful in determining the probability of LTBI in tuberculin skin test positive US born subjects. Of 114 subjects with available treatment information, overall completion rate was 61% and rates of completion in Low (60%), Intermediate (63%) and High (57%) risk groups were equivalent. 75% subjects in the 3HP group completed treatment compared to 58% in the INH group. Provider documentation of important clinical risk factors was often incomplete. Logistic regression analysis showed no clear trends of treatment completion being associated with assessment of a risk factor.ConclusionThese findings suggest tstin3d.com could be utilized in the US setting for risk stratification of patients with LTBI and select treatment based on risk. Current standard of care practice leads to subjects in all groups finishing treatment at equivalent rates.

Tuberculosis in healthcare workers, Scotland

2017 ◽  
Vol 62 (3) ◽  
pp. 101-103 ◽  
Author(s):  
Kevin G Pollock ◽  
Eisin McDonald ◽  
Alison Smith-Palmer ◽  
Fiona Johnston ◽  
Syed Ahmed
Keyword(s):  
Incidence Rate ◽  
Healthcare Workers ◽  
Latent Tuberculosis Infection ◽  
Screening Programme ◽  
Latent Tuberculosis ◽  
Mycobacterial Infection ◽  
Population Based ◽  
Tuberculosis Infection ◽  
The Mean ◽  
The Uk

In an attempt to explore healthcare worker acquisition of tuberculosis infection, we conducted population-based surveillance of all cases recorded as healthcare workers reported to Enhanced Surveillance of Mycobacterial Infection from 2000 to 2015. Over the study period, the mean incidence rate of tuberculosis among all healthcare workers was 15.4 per 100,000 healthcare workers. However, the incidence rate of tuberculosis amongst those healthcare workers born outside the UK was 164.8 per 100,000 compared with 5.0 per 100,000 UK-born healthcare workers. Fifty-seven per cent of all non-UK-born healthcare workers were diagnosed within five years of their arrival in the UK and would have been new entrants to the NHS. An effective new entrant occupational health screening programme for latent tuberculosis infection may have prevented some of these active cases of infection.

scholarly journals Completion Rates, Adverse Effects, and Costs of a 3-Month and 9-Month Treatment Regimen for Latent Tuberculosis Infection in California Inmates, 2011-2014

2019 ◽  
Vol 134 (1_suppl) ◽  
pp. 71S-79S ◽  
Author(s):  
Charlotte Wheeler ◽  
Janet Mohle-Boetani
Keyword(s):  
Latent Tuberculosis Infection ◽  
Treated Patient ◽  
Prison Population ◽  
Latent Tuberculosis ◽  
Treatment Completion ◽  
Completion Rate ◽  
Tuberculosis Infection ◽  
High Rate ◽  
Initiation Rate ◽  
The Cost

Objectives: In California, about 80% of tuberculosis disease is caused by untreated latent tuberculosis infection (LTBI), and the rate of LTBI is higher among incarcerated persons (16%) than among nonincarcerated persons (6%). We compared 2 regimens to treat LTBI in an adult prison population in California: 9 months of twice-weekly isoniazid (9H; previous standard of care) and 12 once-weekly doses of isoniazid and rifapentine (3HP; introduced in 2011). Methods: We evaluated the rates of completion and discontinuation caused by hepatotoxicity among randomly selected patients with LTBI prescribed the 9H regimen in 2011 and among patients with LTBI prescribed the 3HP regimen who entered California prisons during September 2013–March 2014. We compared the cost per fully treated patient for the 2 regimens. Results: Of 92 patients treated with the 9H regimen, the treatment completion rate was 42% and discontinuation due to hepatotoxicity was 14%. Of 122 patients who accepted the 3HP regimen, the completion rate was 90% and discontinuation due to hepatotoxicity was 2%. The cost per fully treated patient for the 9H regimen was $981 and for 3HP was $652. Conclusions: In an incarcerated population, the 3HP regimen had a higher completion rate, lower hepatotoxicity, and lower cost per fully treated patient than the 9H regimen. If coupled with a high treatment initiation rate, the high rate of LTBI treatment completion with 3HP may contribute to reducing tuberculosis morbidity in California.

scholarly journals Immigrant screening for latent tuberculosis infection: numbers needed to test and treat, a Norwegian population-based cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e023412 ◽  
Author(s):  
Brita Askeland Winje ◽  
Gry Marysol Grøneng ◽  
Richard Aubrey White ◽  
Peter Akre ◽  
Preben Aavitsland ◽  
...  
Keyword(s):  
Cohort Study ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Population Based ◽  
Tuberculosis Infection ◽  
Number Needed To Treat ◽  
Ltbi Treatment ◽  
Ltbi Screening ◽  
Number Needed To Screen ◽  
Source Countries

ObjectivesTo estimate the number needed to screen (NNS) and the number needed to treat (NNT) to prevent one tuberculosis (TB) case in the Norwegian immigrant latent tuberculosis infection (LTBI) screening programme and to explore the effect of delay of LTBI treatment initiation.DesignPopulation-based, prospective cohort study.ParticipantsImmigrants to Norway.OutcomeIncident TB.MethodsWe obtained aggregated data on immigration to Norway in 2008–2011 and used data from the Norwegian Surveillance System for Infectious Diseases to assess the number of TB cases arising in this cohort within 5 years after arrival. We calculated the average NNS and NNT for immigrants from the top 10 source countries for TB in Norway and by estimated TB incidence rates in source countries. We explored the sensitivity of these estimates with regard to test performance, treatment efficacy and treatment adherence using an extreme value approach, and assessed the effects of emigration, time to TB diagnosis (to define incident TB) and intervention timing.ResultsNNS and NNT were overall high, with substantial variation. NNT showed numerically stronger negative correlation with TB notification rate in Norway (−0.75 [95% CI −1.00 to −0.44]) than with the WHO incidence rate (IR) (−0.32 [95% CI −0.93 to 0.29]). NNT was affected substantially by emigration and the definition of incident TB. Estimates were lowest for Somali (NNS 99 [70–150], NNT 27 [19–41]) and highest for Thai immigrants (NNS 585 [413–887], NNT 111 [79–116]). Implementing LTBI treatment in immigrants sooner after arrival may improve the effectiveness of the programme.ConclusionUsing TB notifications in Norway, rather than IR in source countries, would improve targeting of immigrants for LTBI management. However, the overall high NNT is a concern and challenges the scale-up of preventive LTBI treatment for significant public health impact. Better data are urgently needed to monitor and evaluate NNS and NNT in countries implementing LTBI screening.

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