异烟肼加利福平 3 个月方案与异烟肼 9 个月方案治疗潜伏性结核感染的肝毒性、疗效和完成率：系统评价和荟萃分析。

Hepatotoxicity, efficacy and completion rate between 3 months of isoniazid plus rifapentine and 9 months of isoniazid in treating latent tuberculosis infection: A systematic review and meta-analysis.

机构信息

Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, and National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC.

出版信息

J Chin Med Assoc. 2021 Nov 1;84(11):993-1000. doi: 10.1097/JCMA.0000000000000605.

DOI:10.1097/JCMA.0000000000000605

PMID:34747900

Abstract

BACKGROUND

The mainstay therapy for latent tuberculosis infection is a 9-month regimen of daily isoniazid (9H) and a 3-month regimen of 12 once-weekly doses of isoniazid and rifapentine (3HP). We performed this updated meta-analysis to compare hepatotoxicity, efficacy and completion rate between these two regimens.

METHODS

We searched all literature in the major medical databases using the subject search terms "isoniazid" and "rifapentine", and performed a systemic review and meta-analysis.

RESULTS

A total of 14 studies were eligible for the meta-analysis, which included 5600 (49%) patients who received the 3HP regimen and 5919 (51%) patients who received the 9H regimen. A total of 202 (2%) patients had a drug-induced liver injury (DILI) and 11 317 (98%) did not. The pooled odds ratio (OR) of DILI in the 3HP regimen was 0.18 (95% confidence interval [CI], 0.12-0.26; p < 0.0001), compared with the 9H regimen. This result remained consistent in subgroup analyses of ethnicity and study design. The 3HP regimen was superior to the 9H regimen in the prevention of active tuberculosis (OR, 0.38, 95% CI, 0.18-0.80, p = 0.01). Furthermore, the 3HP regimen was associated with a better completion rate than the 9H regimen (OR: 2.30, 95% CI, 2.10-2.53, p < 0.0001).

CONCLUSION

The 3HP regimen is superior to the 9H regimen, with less hepatotoxicity, and better efficacy and completion rate in treating latent tuberculosis infection.

摘要

背景

潜伏性结核感染的主要治疗方法是 9 个月的异烟肼（INH）每日治疗方案（9H）和 3 个月的异烟肼和利福平（RIF）每周 12 次治疗方案（3HP）。我们进行了此次更新的荟萃分析，以比较这两种方案的肝毒性、疗效和完成率。

方法

我们使用主题搜索词“异烟肼”和“利福平”在主要医学数据库中搜索所有文献，并进行了系统评价和荟萃分析。

结果

共有 14 项研究符合荟萃分析的条件，其中 5600 名（49%）患者接受了 3HP 方案治疗，5919 名（51%）患者接受了 9H 方案治疗。共有 202 名（2%）患者发生药物性肝损伤（DILI），11317 名（98%）患者未发生。与 9H 方案相比，3HP 方案的 DILI 发生率的合并比值比（OR）为 0.18（95%置信区间[CI]，0.12-0.26；p<0.0001）。在种族和研究设计的亚组分析中，这一结果仍然一致。3HP 方案在预防活动性结核病方面优于 9H 方案（OR：0.38，95%CI，0.18-0.80，p=0.01）。此外，与 9H 方案相比，3HP 方案的完成率更高（OR：2.30，95%CI，2.10-2.53，p<0.0001）。