Four-Month Rifapentine Regimens with or without Moxifloxacin for Tuberculosis
RCT (n=2516 of which 2234 evaluable) found efficacy of 4-month rifapentine-based regimen containing moxifloxacin was non-inferior to standard 6-month regimen (11.6% vs. 9.6%; respectively, difference 2.0 %; 95% CI, −1.1 to 5.1, in assessable population, had unfavourable outcome).
Source:
New England Journal of Medicine
SPS commentary:
An editorial discusses the immediate and longer-term implications of these findings. It notes both rifapentine and moxifloxacin are widely available and could probably be packaged appropriately for use by national tuberculosis programs. In addition, shortening a regimen by 2 months would make treatment somewhat less cumbersome and probably make it more cost-effective. However, it notes the infrastructure required to ensure adherence would be largely unchanged and the need to take rifapentine after meals to maximize absorption could introduce new issues with adherence. Moreover, one of the advantages of the currently used tuberculosis drugs is that they are not widely used in other infections. It notes also that as well as necessitating rapid drug-susceptibility testing for moxifloxacin, widespread use of this antibiotic for the treatment of tuberculosis could promote resistance to fluoroquinolones in other bacteria.