Ann Intern Med. 2014 Sep 16;161(6):419-28. doi: 10.7326/M14-1019.
Effective treatment of latent tuberculosis infection (LTBI) is an important component of TB elimination programs. Promising new regimens that may be more effective are being introduced. Because few regimens can be directly compared, network meta-analyses, which allow indirect comparisons to be made, strengthen conclusions.
To determine the most efficacious regimen for preventing active TB with the lowest likelihood of adverse events to inform LTBI treatment policies.
PubMed, EMBASE, and Web of Science up to 29 January 2014; clinical trial registries; and conference abstracts.
Randomized, controlled trials that evaluated LTBI treatment in humans and recorded at least 1 of 2 prespecified end points (preventing active TB or hepatotoxicity), without language or date restrictions.
Data from eligible studies were independently extracted by 2 investigators according to a standard protocol.
Of the 1516 articles identified, 53 studies met the inclusion criteria. Data on 15 regimens were available; of 105 possible comparisons, 42 (40%) were compared directly. Compared with placebo, isoniazid for 6 months (odds ratio [OR], 0.64 [95% credible interval {CrI}, 0.48 to 0.83]) or 12 months or longer (OR, 0.52 [CrI, 0.41 to 0.66]), rifampicin for 3 to 4 months (OR, 0.41 [CrI, 0.18 to 0.86]), and rifampicin-isoniazid regimens for 3 to 4 months (OR, 0.52 [CrI, 0.34 to 0.79]) were efficacious within the network.
The risk of bias was unclear for many studies across various domains. Evidence was sparse for some comparisons, particularly hepatotoxicity.
Comparison of different LTBI treatment regimens showed that various therapies containing rifamycins for 3 months or more were efficacious at preventing active TB, potentially more so than isoniazid alone. Regimens containing rifamycins may be effective alternatives to isoniazid monotherapy.
None.
有效治疗潜伏性结核感染（LTBI）是结核病消除计划的重要组成部分。目前正在引入一些更有效的新方案。由于很少有方案可以直接进行比较，因此网络荟萃分析（允许进行间接比较）可以增强结论的可信度。
确定最有效的治疗方案来预防活动性结核病，并降低发生不良反应的可能性，为 LTBI 治疗政策提供信息。
PubMed、EMBASE 和 Web of Science 截至 2014 年 1 月 29 日；临床试验注册处；以及会议摘要。
评价 LTBI 治疗的随机对照试验，且至少记录了 2 个预先指定的终点之一（预防活动性结核病或肝毒性），不限制语言或日期。
两名研究人员按照标准方案独立提取符合纳入标准的研究数据。
在确定的 1516 篇文章中，有 53 项研究符合纳入标准。有 15 种治疗方案的数据可用，在 105 种可能的比较中，有 42 种（40%）进行了直接比较。与安慰剂相比，异烟肼治疗 6 个月（比值比[OR]，0.64[95%可信区间{CrI}，0.48 至 0.83]）或 12 个月或更长时间（OR，0.52[CrI，0.41 至 0.66]）、利福平治疗 3 至 4 个月（OR，0.41[CrI，0.18 至 0.86]）和利福平-异烟肼治疗 3 至 4 个月（OR，0.52[CrI，0.34 至 0.79]）在网络内是有效的。
许多研究在各个领域的偏倚风险不明确。一些比较的证据较少，特别是肝毒性。
不同 LTBI 治疗方案的比较表明，含有利福平治疗 3 个月或更长时间的各种治疗方案在预防活动性结核病方面均有效，其效果可能优于单独使用异烟肼。含有利福平的方案可能是异烟肼单药治疗的有效替代方案。
无。
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