To evaluate the efficacy and safety of a modified 3-month rifapentine plus isoniazid regimen compared to the standard 9-month isoniazid regimen for preventing tuberculosis in patients with rheumatic diseases and latent infection.
Key Findings:
Cumulative TB rate was 0% in the 3HP-PUMCH group vs 1.2% in the 9H group.
Adverse drug reactions occurred in 9.6% of the 3HP-PUMCH group vs 15% in the 9H group.
Hepatotoxicity was observed in 4.4% of the 3HP-PUMCH group vs 10.4% in the 9H group.
Treatment completion rates were 89.6% for 3HP-PUMCH and 91.2% for 9H.
Interpretation:
The modified 3-month regimen is noninferior to the standard 9-month regimen, with a favorable safety profile and similar treatment completion rates, suggesting it may be a viable alternative for high-risk patients.
Limitations:
Lack of pharmacokinetic and pharmacogenomic data.
Limited subgroup analyses due to small sample size and low event numbers.
Incomplete capture of comorbidities and concomitant medications.
Lower event rate reduces certainty of findings.
Potential impact of COVID-19 on TB exposure and reporting.
Unclear long-term efficacy and generalizability beyond the studied population.
Conclusion:
The findings support considering short-course TB preventive treatment in patients with rheumatic diseases, highlighting the need for further large-scale trials to confirm results and inform guidelines.
