Improved treatment completion with shorter treatment regimens for latent tuberculous infection
Improved treatment completion with shorter treatment regimens for latent tuberculous infection
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DOI：
10.5588/ijtld.18.0035
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发表时间：
2018-11-01
影响因子：
4
通讯作者：
Burzynski, J.
中科院分区：
文献类型：
--
作者：
Macaraig, M. M.;Jalees, M.;Burzynski, J.
环境：四个纽约市（NYC）卫生部结核病（TB）诊所。目的：评估优先提供两种较短治疗方案的有效性-每日4个月的利福平（4 R）和3个月的每周一次的异烟肼和利福喷丁（3 HP）-作为9个月的每日异烟肼（9 H）治疗潜伏性结核感染（LTBI）的替代方案。设计：2015年1月至6月接受LTBI治疗的患者的回顾性分析。结果：9小时，49%（27/55）的患者完成了治疗，而4 R（P=0.003）和3 HP（P <0.001）的患者分别为70%（187/269）和79%（99/125）。当调整年龄、性别和TB风险因素时，4 R（调整后风险比[aRR] 1.39，95%CI 1.07-1.81）和3 HP（aRR 1.67，95%CI 1.27-2.19）患者比9 H患者更有可能完成治疗。4 R组1%（3/269）、3 HP组2%（2/125）和9 H组4%（2/55）的患者因副作用而停止治疗。结论：大多数患者接受较短的LTBI治疗方案，观察到较高的治疗完成率。鼓励社区提供者使用较短的LTBI治疗方案将减少纽约市的结核病负担。
SETTING: Four New York City (NYC) Health Department tuberculosis (TB) clinics.OBJECTIVE: To assess the effectiveness of preferentially offering two shorter treatment regimens-4 months of daily rifampin (4R) and 3 months of once-weekly isoniazid and rifapentine (3HP)-as an alternative to 9 months of daily isoniazid (9H) for the treatment of latent tuberculous infection (LTBI).DESIGN: Retrospective analysis of patients treated for LTBI from January to June 2015. Poisson regression with robust standard error was used to examine the factors associated with treatment completion.RESULTS: Of the patients on 9H, 49% (27/55) completed treatment compared with 70% (187/269) of patients on 4R (P=0.003) and 79% (99/125) of patients on 3HP (P < 0.001). When adjusting for age, sex, and TB risk factors, patients on 4R (adjusted risk ratio [aRR] 1.39, 95%CI 1.07-1.81) and 3HP (aRR 1.67, 95%CI 1.27-2.19) were more likely to complete treatment than patients on 9H. Treatment was discontinued due to side effects in 1% (3/269) of patients on 4R, 2% (2/125) of patients on 3HP, and 4% (2/55) of patients on 9H.CONCLUSIONS: Most patients were placed on shorter regimens for LTBI treatment, and higher treatment completion was observed. Encouraging community providers to use shorter regimens for LTBI treatment would reduce the TB disease burden in NYC.