Completion, safety, and efficacy of tuberculosis preventive treatment regimens containing rifampicin or rifapentine: an individual patient data network meta-analysis

SPS commentary:

The researchers note that historically, the WHO had recommended daily isoniazid for 6 or 9 months for TB prophylaxis, which have shown good efficacy but linked to poor completion rates and significant hepatotoxicity. In 2020, it recommended a 3-month regimen of weekly rifapentine plus isoniazid (3HP) and 4 months of daily rifampicin (4R) based on results of several RCTs over the past 20 years, but 3HP and 4R have not yet been compared directly in a trial. The current research was conducted to generate and compare indirect estimates of relative treatment completion, safety, and efficacy between 3HP and 4R. It found that people treated with 3HP have ~5% higher treatment completion than those receiving 4R. However, compared with 4R, those treated with 3HP had a 3% higher risk of treatment-related adverse events that led to permanent drug discontinuation and a 2% higher risk of treatment-related grade 3–4 adverse events that led to permanent drug discontinuation. Overall they concluded these data suggest no difference in efficacy for prevention of TB between these regimens, although analysis was limited by the low number of disease occurrences.