潜伏性结核感染的治疗完成情况：一项回顾性队列研究，比较9个月异烟肼、4个月利福平以及3个月异烟肼和利福喷汀的治疗效果。
Treatment completion for latent tuberculosis infection: a retrospective cohort study comparing 9 months of isoniazid, 4 months of rifampin and 3 months of isoniazid and rifapentine.
作者信息
McClintock Adelaide H, Eastment McKenna, McKinney Christy M, Pitney Caroline L, Narita Masahiro, Park David R, Dhanireddy Shireesha, Molnar Alexandra
机构信息
Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Box 354765, 4245 Roosevelt Way NE, Seattle, WA, 98105, USA.
Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, USA.
出版信息
BMC Infect Dis. 2017 Feb 14;17(1):146. doi: 10.1186/s12879-017-2245-8.
BACKGROUND
The U.S. Centers for Disease Control and Prevention (CDC) recommended a new regimen for treatment of latent tuberculosis (three months of weekly isoniazid and rifapentine) in late 2011. While completion rates of this regimen were reported to be higher than nine months of isoniazid, little is known about the completion rates of three months of isoniazid and rifapentine compared to nine months of isoniazid or four months of rifampin in actual use scenarios.
METHODS
We conducted a retrospective cohort study comparing treatment completion for latent tuberculosis (TB) infection in patients treated with nine months of isoniazid, three months of isoniazid and rifapentine or four months of rifampin in outpatient clinics and a public health TB clinic in Seattle, Washington. The primary outcome of treatment completion was defined as 270 doses of isoniazid within 12 months, 120 doses of rifampin within six months and 12 doses of isoniazid and rifapentine within four months.
RESULTS
Three hundred ninety-three patients were included in the study. Patients were equally likely to complete three months of weekly isoniazid and rifapentine or four months of rifampin (85% completion rate of both regimens), as compared to 52% in the nine months of isoniazid group (p < 0.001). These associations remained statistically significant even after adjusting for clinic location and type of monitoring. Monitoring type (weekly versus monthly versus less often than monthly) had less impact on treatment completion than the type of treatment offered.
CONCLUSIONS
Patients were equally as likely to complete the three months of isoniazid and rifapentine as four months of rifampin. Four months of rifampin is similar in efficacy compared to placebo as isoniazid and rifapentine but does not require directly observed therapy (DOT), and is less expensive compared to combination therapy with isoniazid and rifapentine, and thus can be the optimal treatment regimen to achieve the maximal efficacy in a community setting.
背景
2011年末，美国疾病控制与预防中心（CDC）推荐了一种用于治疗潜伏性结核病的新方案（每周服用异烟肼和利福喷汀，疗程为三个月）。虽然据报道该方案的完成率高于九个月的异烟肼治疗方案，但在实际使用场景中，与九个月的异烟肼治疗方案或四个月的利福平治疗方案相比，关于三个月的异烟肼和利福喷汀治疗方案的完成率所知甚少。
方法
我们进行了一项回顾性队列研究，比较了在华盛顿州西雅图的门诊诊所和一家公共卫生结核病诊所中，接受九个月异烟肼治疗、三个月异烟肼和利福喷汀治疗或四个月利福平治疗的潜伏性结核感染患者的治疗完成情况。治疗完成的主要结局定义为在12个月内服用270剂异烟肼、在6个月内服用120剂利福平以及在4个月内服用12剂异烟肼和利福喷汀。
结果
393名患者纳入了该研究。与九个月异烟肼组52%的完成率相比，患者完成三个月每周一次的异烟肼和利福喷汀治疗或四个月利福平治疗的可能性相同（两种方案的完成率均为85%，p<0.001）。即使在调整了诊所位置和监测类型后，这些关联在统计学上仍具有显著性。监测类型（每周、每月或少于每月一次）对治疗完成情况的影响小于所提供的治疗类型。
结论
患者完成三个月异烟肼和利福喷汀治疗的可能性与完成四个月利福平治疗的可能性相同。四个月的利福平在疗效上与异烟肼和利福喷汀联合治疗时的安慰剂相似，但不需要直接观察治疗（DOT），且与异烟肼和利福喷汀联合治疗相比成本更低，因此可以成为在社区环境中实现最大疗效的最佳治疗方案。
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