Updated review confirms efficacy and safety of most standard treatments for latent tuberculosis infection

1. Results of a meta-analysis confirm evidence of efficacy and safety of 6-month isoniazid monotherapy and rifampicin monotherapy for latent tuberculosis infection treatment.

2. Combination therapies with 3 to 4 months of isoniazid and rifampicin were also shown to be safe and effective for latent tuberculosis infection treatment.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Tuberculosis (TB) is one of several priority global infectious diseases, and treatment of latent tuberculosis infection (LTBI) is a highly important component of TB control. The purpose of this systematic review and meta-analysis was to evaluate the comparative efficacy and harms of LTBI treatment regimens aimed at preventing active TB. The analysis focused on treatments used both for adults and children. Generally, the updated network meta-analysis suggested that most standard treatments for LTBI are safe and effective. This study has several limitations. First, there was a paucity of evidence regarding hepatotoxicity outcomes amongst trials. Additionally, there was a high risk of bias to many of the underlying studies, which were small in sample size or used nonstandard end point definitions. Quality and reporting standards also formed further limitations.

Click to read the study, published in the Annals of Internal Medicine

Relevant Reading: Diagnosis and Treatment of Latent Tuberculosis Infection

In-Depth [meta-analysis]: The authors of this study conducted an updated network meta-analysis. Articles were retrieved from PubMed, Embase, and Web of Science from indexing to 8 May 2017, in addition to clinical trial registries and conference abstracts. Inclusion criteria consisted of randomized controlled trials that evaluated human LTBI treatments and recorded at least 1 or 2 endpoints—hepatotoxicity and/or prevention of active TB. Two independent reviewers extracted data. In total, the network meta-analysis included 8 new studies and 53 previously identified studies. In general, safety and efficacy was observed for most standard treatments of LTBI. For example, isoniazid regimens of 6 months (odds ratio [OR], 0.65; 95% credible interval [Crl], 0.50 to 0.83) or 12 to 72 months (OR, 0.50; Crl, 0.41 to 0.62) were efficacious compared to placebo. Similar findings were observed for rifampicin-only regimens, rifampicin-isoniazid regimens of 3 to 4 months, rifampicin-isoniazid-pyrazinamide regimens, and rifampicin-pyrazinamide regimens.

Image: PD

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