Advertisement

 

 

Treatment of Latent Tuberculosis Infection: An Updated Network Meta-analysis.

Treatment of Latent Tuberculosis Infection: An Updated Network Meta-analysis.
Author Information (click to view)

Zenner D, Beer N, Harris RJ, Lipman MC, Stagg HR, van der Werf MJ,


Zenner D, Beer N, Harris RJ, Lipman MC, Stagg HR, van der Werf MJ, (click to view)

Zenner D, Beer N, Harris RJ, Lipman MC, Stagg HR, van der Werf MJ,

Advertisement

Annals of internal medicine 2017 08 01167(4) 248-255 doi 10.7326/M17-0609

Abstract
Background
Treatment of latent tuberculosis infection (LTBI) is an important component of tuberculosis (TB) control, and this study updates a previous network meta-analysis of the best LTBI treatment options to inform public health action and programmatic management of LTBI.

Purpose
To evaluate the comparative efficacy and harms of LTBI treatment regimens aimed at preventing active TB among adults and children.

Data Sources
PubMed, Embase, and Web of Science from indexing to 8 May 2017; clinical trial registries; and conference abstracts. No language restrictions were applied.

Study Selection
Randomized controlled trials that evaluated human LTBI treatments and recorded at least 1 of 2 prespecified end points (hepatotoxicity and prevention of active TB).

Data Extraction
2 investigators independently extracted data from eligible studies and assessed study quality according to a standard protocol.

Data Synthesis
The network meta-analysis of 8 new and 53 previously included studies showed that isoniazid regimens of 6 months (odds ratio [OR], 0.65 [95% credible interval {CrI}, 0.50 to 0.83]) or 12 to 72 months (OR, 0.50 [CrI, 0.41 to 0.62]), rifampicin-only regimens (OR, 0.41 [CrI, 0.19 to 0.85]), rifampicin-isoniazid regimens of 3 to 4 months (OR, 0.53 [CrI, 0.36 to 0.78]), rifampicin-isoniazid-pyrazinamide regimens (OR, 0.35 [CrI, 0.19 to 0.61]), and rifampicin-pyrazinamide regimens (OR, 0.53 [CrI, 0.33 to 0.84]) were efficacious compared with placebo. Evidence existed for efficacy of weekly rifapentine-isoniazid regimens compared with no treatment (OR, 0.36 [CrI, 0.18 to 0.73]). No conclusive evidence showed that HIV status altered treatment efficacy.

Limitation
Evidence was sparse for many comparisons and hepatotoxicity outcomes, and risk of bias was high or unknown for many studies.

Conclusion
Evidence exists for the efficacy and safety of 6-month isoniazid monotherapy, rifampicin monotherapy, and combination therapies with 3 to 4 months of isoniazid and rifampicin.

Primary Funding Source
U.K. National Institute for Health Research. (PROSPERO: CRD42016037871).

Submit a Comment

Your email address will not be published. Required fields are marked *

4 + 14 =

[ HIDE/SHOW ]