Preventing Active Tuberculosis

Rheumatic diseases (RDs) and tuberculosis (TB) have a special connection. As an example, biologics have created a new future for the treatment of RDs, but biologic treatment-related infections (especially TB) can be concerning, especially to TB-endemic nations like India. In a study in The New England Journal of Medicine, researchers aim to assess if a 4-month regimen of rifampin was superior to a 9-month regimen of isoniazid for preventing active TB in persons with latent TB infection. 

For treatment of adults with latent #tuberculosis infection, 4 months of rifampin is non-inferior to 9 months of isoniazid. Benefits include higher rate of treatment completion & better safety. https://t.co/iZ0OLJJD3b pic.twitter.com/FwLuCNuRkm

— NEJM (@NEJM) August 1, 2018

This is interesting, and relevant to Rheumatologists managing latent TB. Except in the UK where rifapentine is not available… https://t.co/C4H2R8BQgA

— Rheumatology & Rheumatology Advances in Practice (@RheumJnl) August 1, 2018

In this open-label trial, adults with latent tuberculosis infection from nine countries were randomly assigned to receive treatment with a 4-month regimen of rifampin or a 9-month regimen of isoniazid for the prevention of confirmed active TB within 28 months after randomization. 

In addition to single R efficacy & safety, we must considered also 10 times more drug interactions than H in some patients with LTI: HIV with several antiretrovirals (eg Dolutegravir) , hepatitis C (eg Sofosbuvir), transplant (eg Bortezomid) & cancer (eg Vincristine)#tuberculosis pic.twitter.com/S3tJkDUIso

— José Valencia (@JValenciaMar) August 3, 2018

Results showed that in the 3,443 patients in the rifampin group, confirmed active tuberculosis developed in 4 and clinically diagnosed active TB developed in 4 during 7732 person-years of follow-up. In the isoniazid group, which had 7,652 patients, confirmed active TB developed in 4 and clinically diagnosed active tuberculosis developed in 5 patients. “The 4-month regimen of rifampin was not inferior to the 9-month regimen of isoniazid for the prevention of active tuberculosis and was associated with a higher rate of treatment completion and better safety,” the researchers concluded. 

For more on other links to arthritis and rheumatic diseases, check out an article on how obesity, hypertension, and diuretic use is linked to gout. 

SOURCE: The New England Journal of Medicine