536. Completion Rate and Safety of Twelve Weekly Doses of Directly Observed Isoniazid and Rifapentine for Latent Tuberculosis Infection
Session: Poster Abstract Session: Latent Tuberculosis Diagnosis and Management
Thursday, October 27, 2016
Room: Poster Hall
  • IDWeek_Poster_Submission_PDF.pdf (309.0 kB)
  • Background: Treatment of latent tuberculosis infection (LTBI) is a cornerstone of TB control. The standard treatment of LTBI is 9 months of daily, self-administered isoniazid (9H). In 2011, the CDC recommended 12 doses of isoniazid and rifapentine (3HP), administered once-weekly and directly observed, based on a clinical trial that demonstrated equal efficacy and a higher completion rate than 9H (82% vs. 69%). The ID clinic at UVMMC began using 3HP in 2012. This study compares the completion rates and safety of 3HP and 9H in a real-world setting.

    Methods: Two matched cohorts were compared. All 82 3HP patients were randomly matched with 82 9H patients. Matching was based on age, sex, refugee, foreign birth, birth in Bhutan, and hospital employee.

    Results: The 2 cohorts of 82 subjects each had a median age of 39 years. 60% were male, 93% were foreign-born, 75% were refugees, 52% were Bhutanese, and 16% were hospital employees. The baseline BMI did not differ. The completion rates did not differ between 3HP and 9H (71% and 75%, respectively, p = .51). For 3HP, males had a higher completion rate than females (80% vs 56%, p = 0.02). For either cohort, the completion rate did not differ by age, foreign birth, refugee, Bhutanese or hospital employment. Adverse reactions were the most common reasons to discontinue therapy (74%). The rate of permanent drug discontinuation due to an adverse event was 23% in the 3HP group and 15% in the 9H group (p = .17). Mean ALT trended up during 9 months of 9H therapy and trended down during 3 months of 3HP, and was significantly higher in the 9H group at week 12 compared to 3HP (p < 0.01). White blood cells, hemoglobin, and platelets did not change during 3HP therapy. No cases of active TB have developed in either cohort.

    Conclusion: In a cohort of predominantly refugees treated in an ID clinic, the 3HP completion rate was not higher than 9H. The rate of permanent discontinuation due to an adverse event was higher for 3HP. Transaminases were not elevated while on 3HP and complete blood counts did not change. The study size and follow-up period did not allow a comparison of efficacy. Adherence with 9H was not assessed. Half of the subjects were refugees from Bhutan. In this setting, 3HP offered a safe and faster treatment of LTBI, but not a greater likelihood of completion.

    Tracey Sweeney, Pharm.D.1, John Ahern, Pharm.D.1 and W. Kemper Alston, MD, MPH2, (1)Pharmacy, University of Vermont Medical Center, Burlington, VT, (2)Infectious Diseases, University of Vermont Medical Center, Burlington, VT


    T. Sweeney, None

    J. Ahern, None

    W. K. Alston, None

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