The online version of this article (doi:10.1186/s12879-017-2377-x) contains supplementary material, which is available to authorized users.
We conducted a systematic review and network meta-analysis (NMA) to examine the efficacy and completion rates of treatments for latent tuberculosis infection (LTBI). While a previous review found newer, short-duration regimens to be effective, several included studies did not confirm LTBI, and analyses did not account for variable follow-up or assess completion.
We searched MEDLINE, Embase, CENTRAL, PubMed, and additional sources to identify RCTs in patients with confirmed LTBI that involved a regimen of interest and reported on efficacy or completion. Regimens of interest included isoniazid (INH) with rifapentine once weekly for 12 weeks (INH/RPT-3), 6 and 9 months of daily INH (INH-6; INH-9), 3–4 months daily INH plus rifampicin (INH/RFMP 3–4), and 4 months daily rifampicin alone (RFMP-4). NMAs were performed to compare regimens for both endpoints.
Sixteen RCTs (n = 44,149) and 14 RCTs (n = 44,128) were included in analyses of efficacy and completion. Studies were published between 1968 and 2015, and there was diversity in patient age and comorbidities. All regimens of interest except INH-9 showed significant benefits in preventing active TB compared to placebo. Comparisons between active regimens did not reveal significant differences. While definitions of regimen completion varied across studies, regimens of 3–4 months were associated with a greater likelihood of adequate completion.
Most of the active regimens showed an ability to reduce the risk of active TB relative to no treatment, however important differences between active regimens were not found. Shorter rifamycin-based regimens may offer comparable benefits to longer INH regimens. Regimens of 3–4 months duration are more likely to be completed than longer regimens.
Additional file 1: Appendix 1. Description of Approach to Literature Search. Appendix 2. Flow Diagram, Process of Study Selection. Appendix 3. Supplementary material regarding data extraction, case definitions and NMA structure. Appendix 4. WinBugs Code for Network Meta-Analyses. Appendix 5. Studies Excluded from NMA. Appendix 6. Detailed Summary of Study Characteristics. Appendix 7. Summary of Risk of Bias Assessments. Appendix 8. Numbers of Studies Per Comparison and Patients Per Treatment for Primary Analyses. Appendix 9. Summary of Results from Pairwise Meta-Analyses. Appendix 10. Results From Sensitivity Analyses. Appendix 11. Model Fit Results from Primary Network Meta-Analyses. Appendix 12. PRISMA NMA Checklist. Appendix 13. Reference list for appendices. (DOCX 1669 kb)12879_2017_2377_MOESM1_ESM.docx
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- Efficacy and completion rates of rifapentine and isoniazid (3HP) compared to other treatment regimens for latent tuberculosis infection: a systematic review with network meta-analyses
Gonzalo G. Alvarez
- BioMed Central
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