Pease C, Amaratunga K R, Alvarez G G
Division of Respirology, University of Ottawa, Ottawa, ON.
Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON.
Can Commun Dis Rep. 2017 Mar 2;43(3-4):67-71. doi: 10.14745/ccdr.v43i34a02.
Despite recent success in reducing its incidence, tuberculosis remains a considerable challenge in Canada, particularly among foreign-born and Indigenous populations. A key component of the strategy for controlling the disease is the treatment of latent tuberculosis infection. The standard treatment consists of isoniazid (INH) daily for nine months. In recent years, shorter regimens have been developed in the hope of increasing rates of treatment acceptance and completion. Of these, the shortest and most recently developed is a combination of INH and rifapentine taken once weekly for 12 doses (3HP), typically using directly observed therapy (DOT). This regimen has been approved by the Food and Drug Administration in the United States but is not yet authorized in Canada. Based on a rapidly expanding number of observational studies and randomized controlled trials, 12 weeks of 3HP appears to have similar efficacy to nine months of INH, a favourable adverse event profile and potentially improved rates of treatment completion. Although rates of treatment acceptance, the role of self-administered therapy and the regimen's cost-effectiveness within the Canadian context remain uncertain, 3HP is a promising alternative to existing treatments for LTBI.
尽管近期在降低结核病发病率方面取得了成功，但结核病在加拿大仍然是一项重大挑战，尤其是在外国出生人群和原住民中。控制该疾病战略的一个关键组成部分是治疗潜伏性结核感染。标准治疗方案是每日服用异烟肼（INH），持续九个月。近年来，为了提高治疗接受率和完成率，已开发出更短疗程的方案。其中，最短且最新开发的方案是将异烟肼和利福喷丁联合使用，每周服用一次，共12剂（3HP），通常采用直接观察治疗（DOT）。该方案已获美国食品药品监督管理局批准，但在加拿大尚未获批。基于快速增加的观察性研究和随机对照试验，12周的3HP方案似乎与九个月的异烟肼治疗效果相似，不良事件情况良好，且可能提高治疗完成率。尽管在加拿大背景下，治疗接受率、自我给药治疗的作用以及该方案的成本效益仍不确定，但3HP是潜伏性结核感染现有治疗方法的一个有前景的替代方案。
