Use of 12-Dose Isoniazid and Rifapentine for the Treatment of Latent Tuberculosis in Connecticut

Bemis, Kelley

BACKGROUND: In December 2011, CDC recommended a new option for the treatment of latent tuberculosis infection (LTBI): 12 weekly doses of isoniazid (INH) and rifapentine (RPT) given by directly observed therapy (DOT). Studies performed in persons with high likelihood for progression to TB disease (e.g., contacts to pulmonary TB cases) indicate the INH-RPT regimen is as effective as 9 months of daily INH and is more likely to be completed. However, use of this regimen has not been assessed in all sub-groups for which it is now being prescribed.

METHODS: The Connecticut Department of Public Health (CDPH) requested that all providers obtain INH-RPT for the treatment of LTBI from CDPH, free-of-charge. To monitor completion of treatment, adverse drug effects, and feasibility of using INH-RPT in Connecticut, active surveillance is done for all INH-RPT prescriptions and DOT logs are requested for each patient. These data were analyzed for the period March 2012, when the regimen was implemented, through December 31^st, 2012.

RESULTS: Fifty-six patients started treatment for LTBI using 12 doses of INH-RPT. The median age was 37 years (range: 14 – 90); 29 (52%) were male. Among patients with known data, 11/49 (22%) were non-Hispanic black, 10/49 (20%) were non-Hispanic white, and 10/49 (20%) were Asian; 18/49 (37%) were Hispanic. Country of origin was known for 51 patients; 34 (67%) were foreign born.

Of 56 patients, 26 (46%) are currently receiving treatment or have planned start dates. Among the remaining 30 patients, 25 (83%) completed treatment and 5 (17%) stopped treatment. Four patients stopped because of nausea, diarrhea, rash, or increased serum transaminase concentrations. One patient stopped because of an event unrelated to treatment.

CONCLUSIONS: Based on tolerability, safety and treatment completion, the early stages of implementing weekly 12-dose INH-RPT for the treatment of LTBI in Connecticut suggest the regimen is a promising alternative to 9 months of daily INH.