Short-Course Isoniazid Plus Rifapentine Directly Observed Therapy for Latent Tuberculosis in Solid-Organ Transplant Candidates

Abstract

For carefully selected SOT candidates, combination INH/RPT weekly given as directly observed therapy seems to be reasonably well tolerated and is associated with a relatively high completion rate. Future larger prospective studies to confirm the safety and high completion rates reported here and to identify the most appropriate SOT candidates for this regimen are warranted.

Short-course isoniazid plus rifapentine therapy for latent tuberculosis in Brazil

“…Another recent clinical trial with 6862 participants confirmed these results and showed high adherence and low hepatotoxicity rates (0.4% versus 1.8%, p<0.01) (6) . Similar findings were observed in studies in children 2-17 years old, in people living with HIV/AIDS on antiretroviral therapy, and in organ transplantation patients (7) (8) (9) . Costeffectiveness studies have demonstrated the reduced economic impact of this new regimen (10) (11) .…”

Tuberculosis in solid organ transplant candidates and recipients

“…A promising treatment regimen studied in the nontransplant setting is a 12 dose weekly directly observed therapy of INH with rifapentine. Lopez de Castilla et al [27] carefully administered this combination to 13 out of 17 pretransplant candidates in a pilot study. Four patients required premature discontinuation for reasons other than hepatotoxicity.…”

Mycobacterial infections in solid organ transplant recipients

“…Other prophylactic alternatives, for which only limited data are available in the SOT population, include isoniazid given twice weekly by directly observed therapy (DOT), rifampicin (with or without isoniazid) for 4 months and weekly rifapentine and isoniazid for 3 months as DOT . These latter alternatives have the benefit of a shorter regimen duration, greater likelihood of therapy completion before transplant and potentially fewer side‐effects.…”