Since the standard preventive TB regimen last 6-9 months and
associated with poor treatment completion rates, the search has been on for
shorter courses without compromising on efficacy. This prompted the current
randomized trial testing the efficacy of a one-month course of rifapentine plus
isoniazid versus the standard isoniazid for up to nine months.
and treatment completion rates are high.
Possible
Limitations of Study & Future Plans
- The study enrolled only adults who were not pregnant or breastfeeding and
adolescents (≥13 years of age) with HIV infection. Hence, the efficacy of the
1-month regimen in younger children, pregnant women and HIV uninfected persons who are at
increased risk needs to be investigated
- The study did not
include data from more recent studies that showed an independent benefit
of antiretroviral therapy in the prevention of TB. Approximately 50
percent of patients in the current study were on ART at
onset of the trial, and more
than 90 percent were
receiving ART by trial completion
- Although rifapentine-containing regimens are effective in TB, the cost
of rifapentine may be an important hurdle to implementation of this
regimen in low-income settings
where TB is common. Measures must
be taken to bring down the cost of the drug
- Prior studies
have shown that co-administration of isoniazid and rifapentine with
efavirenz did not significantly impact efavirenz concentrations, but
further studies are needed to find out about interactions of TB treatment
with more contemporary antiretroviral agents, such as integrase strand
transfer inhibitors, for example, dolutegravir
Summary
In conclusion, the findings of the study confirmed that one-month of daily rifapentine plus isoniazid was comparable in efficacy to nine
months of isoniazid in TB prevention in high-risk patients such as those with
HIV infection, which has been predicted in prior mouse model studies
Matthew J. Saunders, MRCP, of University College London in
England, and Carlton A. Evans, PhD, of Universidad Peruana Cayetano Heredia in
Peru, and an accompanying editorial said:
"Improving the brevity, acceptability,
and safety of preventive therapy is important and will potentially have a major
effect. However, such therapy has to
be considered in the context that several billion people ... are believed
to have asymptomatic latent tuberculosis infection."
References : - Ending Tuberculosis through Prevention - (https://www.nejm.org/doi/full/10.1056/NEJMe1901656?query=featured_home)
Source: Medindia
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