Safety and treatment completion of latent tuberculosis infection treatment in the elderly population—A prospective observational study in Taiwan

Feng, Jia; Huang, Wei; Lin, Shu Min; Wang, Tsai Yu; Lee, Susan Shin Jung; Pan, Shiann; Lin, Chih Bin; Wei, Yiqun; Tung, Chin; Li, Chiao Ping; Su, Wei

doi:10.1016/j.ijid.2020.05.009

Cited by 16 publications

(10 citation statements)

References 24 publications

(41 reference statements)

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“…This suggests that, contrary to long-standing concerns over toxicity, elderly participants were able to take and complete treatment without difficulty. This is in line with other reports ( 34 – 36 ). In a country such as Korea, with its high incidence of active TB among older people, there is a need for preventive therapy to be offered to this population ( 37 ).…”

Section: Discussionsupporting

confidence: 94%

The cascade of care for latent tuberculosis infection in congregate settings: A national cohort analysis, Korea, 2017–2018

et al. 2022

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Background: In 2017, Korea implemented a nationwide project to screen and treat latent tuberculosis infection (LTBI) in high-risk for transmission public congregate settings. We aimed to assess programme success using a cascade of care framework. Materials and methods:We undertook a cohort study of people from three congregate settings screened between March 2017 and December 2018: (1) first-grade high school students, (2) employees of educational institutions, (3) employees of social welfare facilities. We report percentages of participants with LTBI completing each step in the cascade of care model. Poisson regression models were used to determine factors associated with not visiting clinics, not initiating treatment, and not completing treatment.Results: Among the 96,439 participants who had a positive interferon-gamma release assay result, the percentage visiting clinics for further assessment, to initiate treatment, and who then completed treatment were 50.7, 34.7, Frontiers in Medicine 01 frontiersin.org Min et al. 10.3389/fmed.2022.927579and 28.9%, respectively. Compared to those aged 20-34 years, individuals aged < 20 years and aged ≥ 65 years were less likely to visit clinics, though more likely to complete treatment once initiated. Using public health centres rather than private hospitals was associated with people "not initiating treatment" (adjusted risk ratio [aRR], 3.72; 95% confidence interval [CI], 3.95-3.86). Nine-month isoniazid monotherapy therapy was associated with "not completing treatment," compared to 3-month isoniazid and rifampin therapy (aRR, 1.28; 95% CI, 1.16-1.41).Conclusion: Among participants with LTBI from three congregate settings, less than one third completed treatment. Age, treatment centre, and initial regimen were important determinants of losses to care through the cascade.

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Section: Discussionsupporting

confidence: 94%

The cascade of care for latent tuberculosis infection in congregate settings: A national cohort analysis, Korea, 2017–2018

et al. 2022

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“…Its expansion of target population including elderly aged ≥ 65 years is also highlighted. 27 Similar to recent evidence supporting safety and tolerability of LTBI treatment among elderly population, 28 29 30 our study revealed that treatment completion rates tended to increase with increasing age. To increase engagement of LTBI care among elderly populations, strengthening of LTBI education programmes for HCWs should be considered.…”

Section: Discussionsupporting

confidence: 87%

Latent Tuberculosis Cascade of Care Among Healthcare Workers: A Nationwide Cohort Analysis in Korea Between 2017 and 2018

et al. 2022

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Background In 2017, Korea implemented nationwide latent tuberculosis infection (LTBI) project targeting healthcare workers (HCWs). We aimed to assess its performance using the cascade of care model. Methods We included 45,503 employees of medical institutions with positive interferon-gamma release assay result who participated between March 2017 and December 2018. We described percentages of LTBI participants completing each step in the cascade of care. Poisson regression model was conducted to assess individual characteristics and factors associated with not-visiting clinics for further care, not-initiating LTBI treatment, and not-completing treatment. Results Proportions of visiting clinics and initiating and completing treatment in HCWs were 54.9%, 38.5%, and 32.0%, respectively. Despite of less likelihood of visiting clinics and initiating LTBI treatment, older age ≥ 65 years were more likely to complete treatment (adjusted relative risk [aRR], 0.80; 95% confidence interval [CI], 0.64–0.99), compared to young age < 35 years. Compared to nurses, doctors were less likely to visit clinic; however, were more likely to initiate treatment (aRR, 0.88; 95% CI, 0.81–0.96). Those who visited public health centers were associated with not-initiating treatment (aRR, 1.34; 95% CI, 1.29–1.40). When treated at private hospitals, 9-month isoniazid monotherapy was less likely to complete treatment, compared to 3-month isoniazid and rifampicin combination therapy (aRR, 1.33; 95% CI, 1.16–1.53). Conclusion Among employees of medical institutions with LTBI, only one third completed treatment. Age, occupation, treatment center, and initial regimen were significantly related to LTBI treatment performance indicators. Rifampicin-based short treatment regimens were effective under standard of care.

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“…However elderly population (greater than 80 years of age) was found to have a noticeable interruption rate even with the shorter regimens. One of the factors linked to treatment interruption was severe adverse drug reactions (ADRs) [ 32 ].…”

Section: Reviewmentioning

confidence: 99%

Use of Isoniazid Monotherapy in Comparison to Rifamycin-Based Regimen for the Treatment of Patients With Latent Tuberculosis: A Systematic Review

Shahid¹,

Naguit²,

Jakkoju³

et al. 2022

Cureus

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Tuberculosis (TB) is a common infectious disease that is present all around the world. This insidious disease needs drastic measures for its eradication. One of the actions contributing to it is the timely diagnosis and offering suitable treatment options for latent tuberculosis patients. In this review, we will discuss and compare the variety of options available for this purpose. We searched PubMed/Medline, Cochrane library, Google Scholar, and Science Direct to find articles regarding the effectiveness, safety, and completion of any of the five regimens available for latent tuberculosis infection. These options are the most classic and standard nine months of isoniazid given daily, which is now more commonly given as six months course, three months of daily isoniazid and rifampin, three months of weekly isoniazid and rifapentine, and four months of daily rifampin. We looked into free full-text studies published from 2011 to 2021 available in English language and human studies. After applying inclusion/exclusion criteria and removing duplicates and screening, 34 articles were shortlisted for quality assessment check, after which we finalized nine studies. Cochrane risk-of-bias assessment tool was used for quality check of randomized control trials, New-Castle Ottawa tool for observational studies, and assessment of multiple systematic reviews (AMSTAR) tool for systematic reviews. Efficacy was checked by tracking down the new cases of TB in the sample population that took the treatment for latent tuberculosis infection. New rifamycin-based regimens were almost equal in effectiveness to isoniazid regimens. The side effect profile is different for both regimens, but short-duration courses tend to have a higher chance of completion.

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Safety and treatment completion of latent tuberculosis infection treatment in the elderly population—A prospective observational study in Taiwan

Cited by 16 publications

References 24 publications

The cascade of care for latent tuberculosis infection in congregate settings: A national cohort analysis, Korea, 2017–2018

The cascade of care for latent tuberculosis infection in congregate settings: A national cohort analysis, Korea, 2017–2018

Latent Tuberculosis Cascade of Care Among Healthcare Workers: A Nationwide Cohort Analysis in Korea Between 2017 and 2018

Use of Isoniazid Monotherapy in Comparison to Rifamycin-Based Regimen for the Treatment of Patients With Latent Tuberculosis: A Systematic Review

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