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Efficacy, adherence, and safety of latent Tuberculosis infection treatments. Systematic review and Network meta-analysis of randomized controlled trials
Published onJun 13, 2023
Efficacy, adherence, and safety of latent Tuberculosis infection treatments. Systematic review and Network meta-analysis of randomized controlled trials
Background: Treatment of latent tuberculosis infection (LTBI) is effective in preventing progression to TB disease. This study aimed to synthesize available evidence on the efficacy, adherence, and safety of LTBI treatment.
Method: The PRISMA-NMA statement was used to review and report this research. Randomized controlled trials were included. A systematic literature search was done. The network meta-analysis was done using R- studio Version 1.4.1103.
Result: In this review, 42 studies were included, which enrolled 52547 participants were included. The incidence of TB among people living with HIV who have taken 3RHZ (RR 0.40 95% CI 0.23,0.69) as TPT was lower followed by 3RH (RR 0.56 95% CI 0.36,0.89) and 6H (RR 0.62 95% CI 0.45, 0.87). However, 3HP (RR 0.38 95% CI 0.15,0.99) shows a significant reduction on the incidence of TB among HIV negative patients who had TB contact history. Patients’ adherence to TPT was higher among patients who have taken 4R (RR1.38 95% CI 1.0,1.89) followed by 3RH (RR 1.34 95% CI 1.03,1.74) and 2RZ (RR 1.34 95% CI 1.02,1.75).
The proportion of subjects who permanently discontinued a study drug because of adverse event were higher in 3RZ (RR 9.31 95% CI 2.99,28.97), followed by 2RZ (RR7.12 95% CI 1.39, 36.57), and 3RH (RR 3.29 95% CI 1.11, 9.78). The risk of nausea and vomiting was higher among patients who have taken 3HP (RR 5.91 95% CI 2.30,15.20), followed by two months twice a week combination of HP (RR 3.51 95% CI 1.04,11.79). Furthermore, the risk of grade 3 and 4 liver toxicity was significantly higher among patients who have taken 12H (RR 26.04 95%CI 5.88,115.38), followed by 2RZ (RR 18.48 95% CI 4.57,74.77).
Conclusion : From this review, it can be concluded that 3RHZ, 3RH, 6H has a significant impact on the reduction of TB incidence among PLWH and 3HP among HIV negative people who had TB contact history. However, rifampicin and pyrazinamide combinations were significantly associated with adverse events which resulted permanent discontinuation. This may support the current recommended TPT regimen of 3HP and 6H.
Key words: Systematic review, Network meta-analysis, and Tuberculosis preventive therapy
