What is the treatment for Latent Tuberculosis (TB)?

From the Guidelines

Latent tuberculosis (TB) treatment should prioritize short-course rifamycin-based regimens, such as a 3-month course of once-weekly isoniazid plus rifapentine, due to their high effectiveness, safety, and treatment completion rates, as recommended by the National Tuberculosis Controllers Association and CDC in 2020 1.

Key Considerations

• The preferred treatment regimens include 3 months of once-weekly isoniazid plus rifapentine, 4 months of daily rifampin, or 3 months of daily isoniazid plus rifampin, with the choice of regimen depending on patient factors and potential drug interactions 1.
• These regimens are preferred over longer-course isoniazid monotherapy due to their higher treatment completion rates and lower risk of hepatotoxicity 1.
• Before starting treatment, patients should be evaluated to rule out active TB disease through symptom screening, chest X-ray, and sometimes sputum testing, and regular monitoring for medication side effects is essential, particularly liver function tests for those with risk factors 1.

Treatment Options

• A 3-month course of once-weekly isoniazid (900mg) plus rifapentine (900mg) is a preferred regimen, with high completion rates and minimal side effects 1.
• A 4-month daily regimen of rifampin (10mg/kg, up to 600mg) is an alternative option, effective and well-tolerated, but with a longer treatment duration 1.
• The traditional 9-month course of daily isoniazid (5mg/kg, up to 300mg) remains an option, but has higher discontinuation rates due to its length and higher risk of hepatotoxicity 1.

Patient Evaluation and Monitoring

• Patients should be evaluated for active TB disease before starting treatment, using symptom screening, chest X-ray, and sometimes sputum testing 1.
• Regular monitoring for medication side effects is essential, particularly liver function tests for those with risk factors, to minimize the risk of hepatotoxicity and ensure safe treatment 1.

From the FDA Drug Label

PRIFTIN is indicated in adults and children 2 years and older for the treatment of latent tuberculosis infection caused by Mycobacterium tuberculosis in patients at high risk of progression to tuberculosis disease PRIFTIN must always be used in combination with isoniazid as a 12-week once-weekly regimen for the treatment of latent tuberculosis infection

The treatment for Latent Tuberculosis (TB) is PRIFTIN (rifapentine) in combination with isoniazid for 12 weeks, administered once weekly as directly observed therapy. The dose of PRIFTIN is based on the patient's weight, up to a maximum of 900 mg once weekly, and isoniazid is given at a dose of 15 mg/kg (up to 900 mg maximum) for adults and children ≥12 years, and 25 mg/kg (up to 900 mg maximum) for children 2 to 11 years 222.

From the Research

Treatment Options for Latent Tuberculosis (TB)

The treatment for Latent Tuberculosis (TB) includes several options, as outlined below:

• Isoniazid monotherapy for 6-9 months, which has an estimated protective effect of 60%-90% 3
• Rifampin regimen for 4 months, characterized by less hepatotoxicity and better compliance than isoniazid monotherapy, but with limited evidence of clinical efficacy 3
• Three months of isoniazid plus rifampin, which has been proven to be equivalent to isoniazid monotherapy in terms of efficacy and safety 3, 4
• Once-weekly isoniazid plus rifapentine for 3 months, which has been shown to be as effective as 9 months of isoniazid alone in preventing tuberculosis, with a higher treatment-completion rate 5, 4, 6
• Daily isoniazid plus rifapentine for 1 month, which is currently under evaluation as an ultrashort antimicrobial regimen for TB prevention 4

Efficacy and Safety of Treatment Regimens

The efficacy and safety of these treatment regimens have been evaluated in various studies:

• The use of rifapentine plus isoniazid for 3 months was found to be as effective as 9 months of isoniazid alone in preventing tuberculosis, with a higher treatment-completion rate and lower rates of hepatotoxicity 5
• The rifamycin-based regimens for latent TB infection have been successful in preventing progression to TB disease, with once-weekly isoniazid and rifapentine for 12 weeks being shown to be safe and effective compared to 9 months of isoniazid 6
• The adverse event profile of the INH/RPT-3 regimen (12 doses of isoniazid and rifapentine given once weekly) appeared generally favorable, with flu-like reactions reported with an increased frequency and hepatotoxicity with a lower frequency than standard treatment 7

Treatment Completion Rates

Treatment completion rates vary among the different regimens:

• The combination-therapy group (rifapentine plus isoniazid for 3 months) had a treatment completion rate of 82.1%, compared to 69.0% for the isoniazid-only group (9 months of isoniazid) 5
• The use of rifapentine plus isoniazid for 3 months had a higher treatment-completion rate compared to 9 months of isoniazid alone 5, 4