Completion Rate And Safety Of 12-Dose Isoniazid And Rifapentine For Latent Tuberculosis In A Predominantly Refugee Cohort

Background: Latent tuberculosis infection treatment is a cornerstone of tuberculosis control. Standard treatment is 9 months of daily, self-administered isoniazid (9H). In 2011, the Centers for Disease Control and Prevention recommended 12 doses of isoniazid and rifapentine (3HP), administered once weekly and directly observed, based on a clinical trial demonstrating equal efficacy and higher completion rate than the standard of care (82% vs 69%). The infectious disease clinic at the University of Vermont Medical Center began using the 12-dose regimen in 2012. This study compares the completion rates and safety of the 2 treatments in a real-world setting.Methods: Two matched cohorts of 82 patients were compared with matching based on age, sex, refugee, foreign birth, birth in Bhutan, and hospital employee.Results: The completion rates did not differ between 3HP and 9H (71% and 75%, respectively; P = 0.51). For 3HP, males had a higher completion rate than did 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 rates of permanent drug discontinuation due to an adverse event were 23% (3HP group) and 15% (9H group) (P = 0.17).Conclusions: In a cohort of predominantly refugees, completion rates with the 12-dose regimen were not higher than daily, self-administered 9 months of isoniazid. The 12-week regimen was safe and efficient but did not have a higher completion rate.