Treatment Completion for Latent Tuberculosis

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While the direct observation group had the highest rate of treatment completion, 74% and 76.4% of the self administered and self administered with reminders groups, respectively, completed treatment.
While the direct observation group had the highest rate of treatment completion, 74% and 76.4% of the self administered and self administered with reminders groups, respectively, completed treatment.

HealthDay News — Most people complete treatment for latent tuberculosis (TB) without direct observation, according to a study published online in the Annals of Internal Medicine.

Robert Belknap, MD, from the University of Colorado Health Sciences Center in Denver, and colleagues compared treatment completion (11 or more doses within 16 weeks) and safety of once-weekly isoniazid and rifapentine by self-administration versus direct observation. A total of 1002 adult patients with latent tuberculosis infection were recruited from outpatient tuberculosis clinics in the United States (77%), Spain, Hong Kong, and South Africa.

The researchers found that overall, treatment completion was 87.2% (95% CI, 83.1%-90.5%) in the direct observation group , 74% (95% CI, 68.9%-78.6%) in the self-administration group, and 76.4% (95% CI, 71.3%-80.8%) in the self-administration-with-reminders group. In the United States, treatment completion was 85.4% (95% CI, 80.4%-89.4%), 77.9% (95% CI, 72.7%-82.6%), and 76.7% (95% CI, 70.9%-81.7%), respectively, and self-administered therapy without reminders was noninferior to direct observation. No other comparisons met noninferiority criteria.

"This self-administered regimen with monthly monitoring may be an acceptable strategy for treating latent TB infection in the United States and could be considered in countries with similar approaches to TB prevention when directly observed therapy is not feasible," conclude the authors.

Disclosures: Several authors disclosed ties to pharmaceutical companies, including Sanofi, which donated study drugs.

References

  1. Belknap R, Holland D, Feng P-J, et al; for the TB Trials Consortium iAdhere Study Team. Self-administered versus directly observed once-weekly isoniazid and rifapentine treatment of latent tuberculosis infection: a randomized trial [published online November 7, 2017]. Ann Intern Med. doi:10.7326/M17-1150
  2. Getahun H, Matteelli A. Tailoring treatment of latent tuberculosis to the needs of patients and families [published online November 7, 2017]. Ann Intern Med. doi:10.7326/M17-2639

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