Treatment for Preventing Tuberculosis in Children and Adolescents

Villarino, Margarita E.; Scott, Nigel; Weis, Stephen E.; Weiner, Marc; Conde, Marcus Barreto; Jones, Brenda; Nachman, Sharon; Oliveira, Ricardo Hugo de; Moro, Ruth N.; Shang, Nong; Goldberg, Stefan; Sterling, Timothy R.

doi:10.1001/jamapediatrics.2014.3158

Cited by 189 publications

(79 citation statements)

References 22 publications

(24 reference statements)

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“…The preferred treatment for children age 2–11 years is 9H because data and experience with the 3HP regimen among this age group is limited [2]. However, our data are consistent with findings in 1 clinical trial: children age 2–17 years were more likely to complete treatment than any other age group and the regimen was well-tolerated [11]. …”

Section: Discussionsupporting

confidence: 82%

“…Of those who did report ≥1 reaction, 1 in 5 discontinued treatment. Children, adolescents, and younger adults were most likely to complete treatment, but even patients aged ≥65 years had higher completion rates for 3HP than observed with standard INH regimens overall [4, 10–11]. The preferred treatment for children age 2–11 years is 9H because data and experience with the 3HP regimen among this age group is limited [2].…”

Section: Discussionmentioning

confidence: 99%

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High Rate of Treatment Completion in Program Settings With 12-Dose Weekly Isoniazid and Rifapentine for Latent Mycobacterium tuberculosis Infection

Sandul

Nwana

Holcombe

et al. 2017

Clinical Infectious Diseases

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Background RCTs demonstrated the newest LTBI regimen, 12 weekly doses of directly observed isoniazid and rifapentine (3HP), as efficacious as 9 months of isoniazid (9H) with a greater completion rate (82% versus 69%); however, 3HP has not been assessed in routine health care settings. Methods Observational cohort of LTBI patients receiving 3HP through 16 US programs was used to assess treatment completion, adverse drug reactions (ADRs), and factors associated with treatment discontinuation. Results Of 3288 patients eligible to complete 3HP, 2867 (87.2%) completed treatment. Children 2–17 years had the highest completion rate, 94.5% (155/164). Patients reporting homelessness had a completion rate of 81.2% (147/181). In univariable analyses, discontinuation was lowest among children (relative risk [RR], 0.44 [95% CI, 0.23–0.85]; P = .014), and highest in persons ≥65 years (RR, 1.72 [95% CI, 1.25–2.35] P = .001). In multivariable analyses, discontinuation was lowest among contacts of patients with TB disease (adjusted relative risk [ARR], 0.68 [95% CI, 0.52–0.89]; P = .005), and students (ARR, 0.45 [95% CI, 0.21–0.98]; P = .044); highest with incarceration (ARR, 1.43 [95% CI, 1.08–1.89]; P=.013) and homelessness (ARR, 1.72 [95% CI, 1.25–2.39]; P = .001). ADRs were reported by 1174 (35.7%) patients, of whom 891 (76.0%) completed treatment. Conclusions Completion of 3HP in routine health care settings was greater overall than rates reported from clinical trials, and greater than historically observed using other regimens among reportedly nonadherent populations. Widespread use of 3HP for LTBI treatment could accelerate elimination of TB disease in the United States.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

High Rate of Treatment Completion in Program Settings With 12-Dose Weekly Isoniazid and Rifapentine for Latent Mycobacterium tuberculosis Infection

Sandul

Nwana

Holcombe

et al. 2017

Clinical Infectious Diseases

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“…Comme dans le cas d'autres essais randomisés contrôlés plus récents, le 3HP a été évalué en thérapie sous observation directe (18)(19)(20)(21). Cet essai, qui a comparé le 3HP à un schéma prévoyant la prise quotidienne de RMP et de pyrazinamide pendant deux mois, a révélé que le 3HP était aussi efficace pour prévenir la tuberculose active, en plus d'avoir moins d'effets indésirables (18).…”

Section: Efficacité Du Traitementunclassified

“…Pour autant que nous sachions, aucun essai comparant le 3HP auto-administré à l'INH9 n'a été publié. Des résultats comparables ont été obtenus lors d'une étude de suivi de l'essai PREVENT TB, menée cette fois-ci auprès d'une population pédiatrique (21). Une revue systématique Cochrane (22) en 2013 et une récente méta-analyse en réseau corroborent également l'efficacité du 3HP (14).…”

Section: Efficacité Du Traitementunclassified

“…Cependant, les taux d'hépatotoxicité chez les patients sous 3HP ont été inférieurs à ceux observés avec les traitements de comparaison dans tous les essais randomisés contrôlés (18)(19)(20)(21). Durant l'essai PREVENT TB, une hépatotoxicité a été observée chez 18 patients sur 4 040 (0,4 %) du groupe 3HP, contre 103 patients sur 3 759 (2,7 %) dans le groupe INH9 (20).…”

Section: éVénements Indésirablesunclassified

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