Mycophenolate is Not Used for Latent Tuberculosis Treatment
Mycophenolate (CellCept) is not recommended or approved for the treatment of latent tuberculosis infection (LTBI). According to current guidelines from the CDC and National Tuberculosis Controllers Association, the preferred treatments for LTBI are short-course rifamycin-based regimens, with isoniazid-based regimens as alternatives 1.
Recommended Treatment Regimens for LTBI
Preferred Regimens (Short-Course)
- 3-month once-weekly isoniazid plus rifapentine (for adults and children ≥2 years)
- 4-month daily rifampin (higher completion rates and less hepatotoxicity than isoniazid)
Alternative Regimens
- 6-month daily isoniazid (substantial protection but less than 9-month regimen)
- 9-month daily isoniazid (>90% protection when completed adequately)
- 3-4 month isoniazid plus rifampin (comparable efficacy to 9-month isoniazid)
Evidence Supporting Current Recommendations
The 2020 CDC guidelines strongly recommend short-course rifamycin-based regimens over longer-course isoniazid monotherapy due to similar efficacy with better tolerability and higher treatment completion rates 1. These recommendations are based on high-quality evidence from randomized controlled trials.
A 2018 study published in the New England Journal of Medicine found that a 4-month rifampin regimen was non-inferior to 9 months of isoniazid for preventing active TB, with higher completion rates and better safety profile 2.
Treatment Selection Considerations
When selecting an LTBI treatment regimen, consider:
- Drug interactions: Rifamycins have significant drug-drug interactions
- Comorbidities: HIV status, liver disease, pregnancy
- Age: Children generally tolerate isoniazid better than adults
- Suspected resistance: Different regimens for contacts of drug-resistant TB cases
Important Monitoring and Safety Considerations
- Rule out active TB before starting LTBI treatment to prevent development of drug resistance
- Monitor for hepatotoxicity, particularly with isoniazid regimens
- Children require monthly clinical evaluations to assess adherence and adverse effects
- Baseline liver function tests are recommended for patients with risk factors (HIV, liver disorders)
Why Mycophenolate is Not Used
Mycophenolate mofetil (CellCept) is an immunosuppressive agent used primarily in transplant recipients and autoimmune disorders. It is not included in any guidelines for LTBI treatment 1, 3. In fact, as an immunosuppressant, mycophenolate could potentially increase the risk of progression from latent to active TB by suppressing the immune system's ability to contain the infection.
The evidence-based regimens listed above have demonstrated efficacy in preventing progression to active TB disease, with completion rates and safety profiles that have been extensively studied 4, 2, 5, 6, 7.