2113. Safety & Benefits of Directly Observed Therapy with Rifapentine and Isoniazid for Latent Tuberculosis Infection – Less is More?
Session: Poster Abstract Session: Diagnostics Mycobacteriology
Saturday, October 7, 2017
Room: Poster Hall CD
Background: Latent tuberculosis infection (LTBI) treatment is essential in preventing the reactivation of tuberculosis. We compared the clinical and demographic characteristics of patients that have completed traditional therapy with 9 months of isoniazid (9H) with those that have completed 3 months of rifapentine plus isoniazid using directly observed therapy (3HP), focusing on adverse effects, a barrier to completion that may contribute to discontinuation of therapy.

Methods: We conducted a retrospective chart review (July 2013-March 2017) to compare the 9H group and 3HP group. Demographic and clinical variables were described by therapy type and groups were compared using Fisher’s exact test or t-test, as appropriate.

Results: Patients in the study sample (n=124) had a mean age of 49.8 (SD=14.8) years old. Approximately half received 3HP (n=64, 51.6%). Demographics in the 3HP and 9H groups were similar. Significantly more patients in the 3HP group completed treatment (81.3% vs. 61.7%, P<0.0001). No patients were lost to follow-up in the 3HP group, 14 (23.33%) were lost in the 9H group. Gastrointestinal (GI) upset (n=16), elevated liver function tests (LFTs) (n=11), and headaches (n=9) were the most frequent side effects. Except for neuropathy and pancreatitis, all other adverse side effects had higher incidence in the 3HP group. Specifically, the incidence of GI symptoms (23.4% vs. 1.7%, p=0.0003), weakness (9.4% vs. 0%, p=0.028), and headache (14.1% vs. 0%, p=0.003) were significantly higher in the 3HP group. Of the observed patients with adverse reactions that received 3HP, 88.24% (n=30) had them resolved within the first two weeks.

Conclusion: The 3HP group had a higher completion rate and no loss to follow-up compared to 23% loss to follow-up in the 9H group, however, adverse reactions were significantly higher in the 3HP group. Closer weekly monitoring of the 3HP group could lend itself to capturing more adverse reactions, however, 88% of those adverse reactions resolved within the first two weeks of therapy. Liver function tests were not significantly different (p=0.2079) between the two groups, and were mildly elevated. We conclude that three months of rifapentine plus isoniazid for the treatment of LTBI may be a favorable option over the traditional 9 months of isoniazid in certain populations.

Lawrence Ha, MD1, Megan Lam, PharmD2, Negin Niknam, MD3, Rebecca Schwartz, PhD4, Rehana Rasul, MA, MPH5, Loyce Mol, PharmD2, Suzan Chin, CPhT2, Marcia Epstein, MD, FIDSA6, David Hirschwerk, MD2, Elizabeth Revere, MD2 and Lisa Hayes, MD2, (1)Department of Infectious Diseases, Northwell Health, Hofstra Northwell School of Medicine, Manhasset, NY, (2)Infectious Diseases, Northwell Health, North Shore University Hospital, Manhasset, NY, (3)Infectious Disease, Hofstra university, North Shore - LIJ Hospital, Manhasset, NY, (4)Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra-Northwell, Manhasset, NY, (5)Biostatistics, Northwell Health, Feinstein Institute of Medical Research, Manhasset, NY, (6)Infectious Diseases, Hofstra North Shore - LIJ Health System, Manhasset, NY

Disclosures:

L. Ha, None

M. Lam, None

N. Niknam, None

R. Schwartz, None

R. Rasul, None

L. Mol, None

S. Chin, None

M. Epstein, None

D. Hirschwerk, None

E. Revere, None

L. Hayes, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.