Treatment with isoniazid or rifampin for latent tuberculosis infection: population-based study of hepatotoxicity, completion and costs

Abstract

Clinical trials suggest less hepatotoxicity and better adherence with 4 months rifampin (4R) versus 9 months isoniazid (9H) for treating latent tuberculosis infection (LTBI). Our objectives were to compare frequencies of severe hepatic adverse events and treatment completion, and direct health system costs of LTBI regimens 4R and 9H, in the general population of the province of Quebec, Canada, using provincial health administrative data.Our retrospective cohort included all patients starting rifampin or isoniazid regimens between 2003 and 2007. We estimated hepatotoxicity from hospitalisation records, treatment completion from community pharmacy records and direct costs from billing records and fee schedules. We compared rifampin to isoniazid using logistic (hepatotoxicity), log-binomial (completion), and gamma (costs) regression, with adjustment for age, co-morbidities and other confounders.10 559 individuals started LTBI treatment (9684 isoniazid; 875 rifampin). Rifampin patients were older with more baseline co-morbidities. Severe hepatotoxicity risk was higher with isoniazid (n=15) than rifampin (n=1), adjusted OR=2.3 (95% CI: 0.3–16.1); there were two liver transplants and one death with isoniazid and none with rifampin. Overall, patients without co-morbidities had lower hepatotoxicity risk (0.1% versus 1.0%). 4R completion (53.5%) was higher than 9H (36.9%), adjusted RR=1.5 (95% CI: 1.3–1.7). Mean costs per patient were lower for rifampin than isoniazid: adjusted cost ratio=0.7 (95% CI: 0.5–0.9).Risk of severe hepatotoxicity and direct costs were lower, and completion was higher, for 4R than 9H, after adjustment for age and co-morbidities. Severe hepatotoxicity resulted in death or liver transplant in three patients receiving 9H, compared with no patients receiving 4R.

Toward patient-centered tuberculosis preventive treatment: preferences for regimens and formulations in Lima, Peru

“…The perception that shorter regimens would reduce medication fatigue and interference with daily life suggests that treatment completion could be improved by using shorter regimens, as has been observed in low-burden settings. 5-7 In addition, we found that caregivers were mainly concerned with having child-friendly formulations. Finally, we observed heterogeneity among participants’ regimen preferences, suggesting that adherence might be best supported by having multiple treatment options available.…”

“…3,4 However, shorter regimens with equal efficacy are available in high-income countries, and significantly better treatment completion has been observed under programmatic conditions. [5][6][7] Much emphasis has recently been placed on creating patient-centered models of TB care, which includes addressing individual patient needs and preferences. 8 However, there are very few published reports of patients having been asked about their preferences for preventive therapy regimens.…”

“…3,4 However, shorter regimens with equal efficacy are available in high-income countries, and significantly better treatment completion has been observed under programmatic conditions. 5-7…”

A scoping review of paediatric latent tuberculosis infection care cascades: initial steps are lacking

“…82 Two studies from Canada showed opposite effects of provider type on treatment completion, with one showing decreased odds of treatment completion when prescribers were primary care physicians, 32 while the other found no difference in completion rates based on provider type. 140 Behavioural strategies to optimise adherence and treatment completion A prior review of reviews of IPT adherence promotion methods identified two reviews that included studies with paediatric patients, and each review included only a single study with children and adolescents. 141 The authors concluded there was little evidence supporting effectiveness of specific paediatric TPT adherence promotion strategies, although integration of TB and HIV services might improve adherence.…”

Novel Rifampicin and Indocyanine Green Co-Loaded Perfluorocarbon Nanodroplets Provide Effective In Vivo Photo–Chemo–Probiotic Antimicrobility against Pathogen of Acne Vulgaris Cutibacterium acnes

“…Some of medicines, such as tetracycline, doxycycline, minocycline, and erythromycin, may be able to further suppress the inflammatory response to relieve pain for patients [ 5 ]. However, long-term or overuse of antibiotics may generate microbial drug resistance and/or induce detrimental side effects, such as pigmental change, atrophy, skin irritation, hepatotoxicity, and/or birth defects [ 6 , 7 , 8 , 9 , 10 ], that highly hinder the utilization of antibiotics in the clinic.…”