Treatment for latent tuberculosis infection (LTBI) among patients between age 65 and 78 years has been shown to be relatively well tolerated, with completion rates decreasing according to age.
A retrospective multicenter study on the topic was conducted at the Hallym University Medical Centre in South Korea, with the results published in the journal Respiratory Medicine.
Realizing that insufficient data are available on the treatment of LTBIs among elderly adults, investigators explored the completion rates of LTBI therapy in this population. The study was performed at 5 different university hospitals across South Korea, all part of Hallym University Medical Centre. The researchers reviewed the electronic medical records of all patients aged ≥65 years who had been diagnosed with LTBI via the use of positive interferon-gamma release assay (IGRA) results from January 2016 through December 2018. Treatment completion was defined as ingestion of >80% of all prescribed medications with no loss to follow-up.
During the study period, a total of 127 patients aged ≥65 years with an LTBI visited a hospital outpatient department. Of these patients, 77 between age 65 and 78 years (median age, 69 years) who received treatment for LTBI were evaluated. The most common reasons for IGRA testing in elderly patients included being a healthcare worker (n=33) and being a household contact of an individual with infectious TB (n=18).
The overall completion rate of LTBI treatment based on the initial regimen was 83.1% (n=64). Completion rates of the individual treatment regimens used were: 75.0% in patients who received 9 months of isoniazid monotherapy (9 of 12 patients), 77.3% in patients who received rifampin daily for 4 months (17 of 22 patients), and 88.4% in patients who received rifampin plus isoniazid daily for 3 months (38 of 43 patients).
Adverse events were reported in 29.9% of patients, with an increase in aminotransferase levels being the most common adverse effect (14.3% of patients). In patients with elevated aminotransferase levels, the median alanine aminotransferase and aspartate aminotransferase levels were 53 IU/L and 55 IU/L, respectively. Overall, 3 patients with an adverse event discontinued treatment and 10 patients were lost to follow-up.
The investigators concluded that when LTBI treatment is administered in elderly adults, more careful monitoring is warranted in order to decrease the loss to follow-up, which may help to improve the completion of therapy.
Noh CS, Kim HI, Choi H, et al. Completion rate of latent tuberculosis infection treatment in patients aged 65 years and older [published online September 9, 2019]. Respir Med. 2019;157:52-58.