The following is a summary of “Assessment for Antibodies to Rifapentine and Isoniazid in Persons Developing Flu-like Reactions During Treatment of Latent Tuberculosis Infection,” published in the April 2024 issue of Infectious Disease by Moro et al.
Researchers conducted a retrospective study investigating associations between anti-rifampin antibodies and flu-like reactions following exposure to rifampin, rifapentine, or isoniazid.
They assessed participants from the PREVENT TB study who received three months of weekly isoniazid + rifapentine (3HP) or 9 months of daily isoniazid (9H) for M. tuberculosis (TB) infection treatment. Flu-like reactions were defined as grade ≥2 of any flu-like symptoms. Control groups (3HP or 9H) didn’t report flu-like reactions. A competitive ELISA was developed to detect antibodies against rifapentine, isoniazid, rifampin, and rifapentine metabolites.
The results showed 128 participants, 69 received 3HP (22 experienced flu-like reactions, 47 were controls), and 59 received 9H (12 experienced flu-like reactions; 47 were controls). Among those on 3HP, anti-rifapentine IgG was detected in 2 out of 22 participants with flu-like responses (9%). In 6 out of 47 controls (13%) (P=0.7), anti-isoniazid IgG was detected in 2 out of 22 participants with flu-like reactions (9%) and in 4 out of 47 controls (9%) (P=0.9). Anti-rifapentine metabolite IgG was detected in 2 out of 47 controls (4%) (P=0.9). Among those on 9H, IgG and IgM anti-isoniazid antibodies were each present in 4 out of 47 controls (9%), respectively, but none among participants with flu-like reactions; anti-rifapentine IgG antibodies were not present in any participants with flu-like reactions or controls.
Investigators concluded that although antibodies against rifapentine, isoniazid, and the rifapentine metabolite were identified, the presence was not linked to flu-like reactions, suggesting these reactions were not antibody-mediated.
Source: academic.oup.com/jid/advance-article-abstract/doi/10.1093/infdis/jiae180/7653882