Pease Christopher, Hutton Brian, Yazdi Fatemeh, Wolfe Dianna, Hamel Candyce, Quach Pauline, Skidmore Becky, Moher David, Alvarez Gonzalo G
Department of Medicine, The Ottawa Hospital, Ottawa, Canada.
Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada.
BMC Infect Dis. 2017 Apr 11;17(1):265. doi: 10.1186/s12879-017-2377-x.
We conducted a systematic review and network meta-analysis (NMA) to examine the efficacy and completion rates of treatments for latent tuberculosis infection (LTBI). While a previous review found newer, short-duration regimens to be effective, several included studies did not confirm LTBI, and analyses did not account for variable follow-up or assess completion.
We searched MEDLINE, Embase, CENTRAL, PubMed, and additional sources to identify RCTs in patients with confirmed LTBI that involved a regimen of interest and reported on efficacy or completion. Regimens of interest included isoniazid (INH) with rifapentine once weekly for 12 weeks (INH/RPT-3), 6 and 9 months of daily INH (INH-6; INH-9), 3-4 months daily INH plus rifampicin (INH/RFMP 3-4), and 4 months daily rifampicin alone (RFMP-4). NMAs were performed to compare regimens for both endpoints.
Sixteen RCTs (n = 44,149) and 14 RCTs (n = 44,128) were included in analyses of efficacy and completion. Studies were published between 1968 and 2015, and there was diversity in patient age and comorbidities. All regimens of interest except INH-9 showed significant benefits in preventing active TB compared to placebo. Comparisons between active regimens did not reveal significant differences. While definitions of regimen completion varied across studies, regimens of 3-4 months were associated with a greater likelihood of adequate completion.
Most of the active regimens showed an ability to reduce the risk of active TB relative to no treatment, however important differences between active regimens were not found. Shorter rifamycin-based regimens may offer comparable benefits to longer INH regimens. Regimens of 3-4 months duration are more likely to be completed than longer regimens.
我们进行了一项系统评价和网状Meta分析（NMA），以研究潜伏性结核感染（LTBI）治疗的疗效和完成率。虽然之前的一项综述发现新的短疗程方案有效，但纳入的几项研究未确诊LTBI，且分析未考虑随访时间的差异或评估完成情况。
我们检索了MEDLINE、Embase、CENTRAL、PubMed及其他来源，以确定确诊LTBI患者中涉及感兴趣方案并报告疗效或完成情况的随机对照试验（RCT）。感兴趣的方案包括异烟肼（INH）与利福喷汀每周一次，共12周（INH/RPT-3）、每日服用INH 6个月和9个月（INH-6；INH-9）、每日服用INH加利福平3 - 4个月（INH/RFMP 3 - 4）以及仅每日服用利福平4个月（RFMP-4）。进行NMA以比较两种终点的方案。
16项RCT（n = 44,149）和14项RCT（n = 44,128）纳入了疗效和完成情况分析。研究发表于1968年至2015年之间，患者年龄和合并症存在差异。与安慰剂相比，除INH-9外，所有感兴趣的方案在预防活动性结核病方面均显示出显著益处。活性方案之间的比较未发现显著差异。虽然不同研究中方案完成的定义不同，但3 - 4个月的方案与充分完成的可能性更大相关。
大多数活性方案相对于未治疗显示出降低活动性结核病风险的能力，但未发现活性方案之间的重要差异。基于利福霉素的较短疗程方案可能与较长的INH方案具有相似的益处。3 - 4个月疗程的方案比更长疗程的方案更有可能完成。
