Efficacy of Short-course Weekly Isoniazid and Rifapentine Regimen as Tuberculosis Preventive Treatment among Population at Risk of Developing Disease: A Systematic Review and Meta-analysis

Abstract

Introduction: Tuberculosis (TB) remains a major public health problem in India. Individuals with latent infection do not have active disease and cannot spread Tuberculosis Infection (TBI). The prevalence of latent TB in India is very high, ranging from 40-50%. About 5 to 10% of them may convert into active TB disease. The national program primarily recommends treatment for active TB, while treatment of latent TB is recommended only in special situations. Aim: To assess the efficacy of short-course weekly Isoniazid and Rifapentine (HP) regimen as Tuberculosis Preventive Treatment (TPT) among various risk groups. Materials and Methods: A systematic review and meta-analysis were conducted, involving of about 10 Randomised Control Trials (RCTs). Studies published between 2006 and 2023 were included. Online databases such as PubMed, Google Scholar, Clinical Trial Registry India, and grey literature were searched using keywords like Isoniazid, Rifapentine, and trial. Results: In terms of TB incidence, the pooled risk ratio favoured the weekly HP regimen, estimated at 0.69 (0.49, 0.97, 95% CI). Regarding the incidence of hepatotoxicity, the weekly HP regimen showed neither superiority nor inferiority to comparators, with a pooled risk ratio of 0.50 (0.23, 1.05, 95% CI). The odds of completing treatment were 2.19 times greater for the weekly HP regimen than for controls, with a pooled odds ratio of 2.19 (1.64, 2.92; 95% CI). Conclusion: The weekly HP regimen is superior to other regimens in reducing the incidence of TB. Additionally, the duration of the HP regimen is shorter compared to the commonly advised nine-month Isoniazid regimen. Compared with the daily dosage of Isoniazid, the weekly HP regimen offers better compliance. It also exhibits a significantly higher treatment completion rate. In summary, the weekly HP regimen is superior to other regimens.