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Delgado Moya EM, Ordoñez JA, Alves Rubio F, Niskier Sanchez M, de Oliveira RB, Volmir Anderle R, Rasella D. A Mathematical Model for the Impact of 3HP and Social Programme Implementation on the Incidence and Mortality of Tuberculosis: Study in Brazil. Bull Math Biol 2024; 86:61. [PMID: 38662288 DOI: 10.1007/s11538-024-01285-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/19/2024] [Indexed: 04/26/2024]
Abstract
In this paper, we presented a mathematical model for tuberculosis with treatment for latent tuberculosis cases and incorporated social implementations based on the impact they will have on tuberculosis incidence, cure, and recovery. We incorporated two variables containing the accumulated deaths and active cases into the model in order to study the incidence and mortality rate per year with the data reported by the model. Our objective is to study the impact of social program implementations and therapies on latent tuberculosis in particular the use of once-weekly isoniazid-rifapentine for 12 weeks (3HP). The computational experimentation was performed with data from Brazil and for model calibration, we used the Markov Chain Monte Carlo method (MCMC) with a Bayesian approach. We studied the effect of increasing the coverage of social programs, the Bolsa Familia Programme (BFP) and the Family Health Strategy (FHS) and the implementation of the 3HP as a substitution therapy for two rates of diagnosis and treatment of latent at 1% and 5%. Based of the data obtained by the model in the period 2023-2035, the FHS reported better results than BFP in the case of social implementations and 3HP with a higher rate of diagnosis and treatment of latent in the reduction of incidence and mortality rate and in cases and deaths avoided. With the objective of linking the social and biomedical implementations, we constructed two different scenarios with the rate of diagnosis and treatment. We verified with results reported by the model that with the social implementations studied and the 3HP with the highest rate of diagnosis and treatment of latent, the best results were obtained in comparison with the other independent and joint implementations. A reduction of the incidence by 36.54% with respect to the model with the current strategies and coverage was achieved, and a greater number of cases and deaths from tuberculosis was avoided.
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Affiliation(s)
- Erick Manuel Delgado Moya
- Institute of Collective Health (ISC), Federal University of Bahia (UFBA), Rua Basilio da Gama, Salvador, Bahia, 40.110-040, Brazil.
| | - Jose Alejandro Ordoñez
- Institute of Collective Health (ISC), Federal University of Bahia (UFBA), Rua Basilio da Gama, Salvador, Bahia, 40.110-040, Brazil
| | - Felipe Alves Rubio
- Institute of Collective Health (ISC), Federal University of Bahia (UFBA), Rua Basilio da Gama, Salvador, Bahia, 40.110-040, Brazil
| | - Mauro Niskier Sanchez
- Institute of Collective Health (ISC), Federal University of Bahia (UFBA), Rua Basilio da Gama, Salvador, Bahia, 40.110-040, Brazil
- Department of Public Health, University of Brasilia, Campus Universitarios Darcy Ribeiro, Brasilia, Brasilia-DF, 70.910900, Brazil
| | - Robson Bruniera de Oliveira
- Institute of Collective Health (ISC), Federal University of Bahia (UFBA), Rua Basilio da Gama, Salvador, Bahia, 40.110-040, Brazil
| | - Rodrigo Volmir Anderle
- Institute of Collective Health (ISC), Federal University of Bahia (UFBA), Rua Basilio da Gama, Salvador, Bahia, 40.110-040, Brazil
| | - Davide Rasella
- Institute of Collective Health (ISC), Federal University of Bahia (UFBA), Rua Basilio da Gama, Salvador, Bahia, 40.110-040, Brazil
- Institute of Global Health (ISGlobal), Barcelona, Spain
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Semitala FC, Kadota JL, Musinguzi A, Welishe F, Nakitende A, Akello L, Kunihira Tinka L, Nakimuli J, Ritar Kasidi J, Bishop O, Nakasendwa S, Baik Y, Patel D, Sammann A, Nahid P, Belknap R, Kamya MR, Handley MA, Phillips PPJ, Katahoire A, Berger CA, Kiwanuka N, Katamba A, Dowdy DW, Cattamanchi A. Comparison of 3 optimized delivery strategies for completion of isoniazid-rifapentine (3HP) for tuberculosis prevention among people living with HIV in Uganda: A single-center randomized trial. PLoS Med 2024; 21:e1004356. [PMID: 38377166 PMCID: PMC10914279 DOI: 10.1371/journal.pmed.1004356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/05/2024] [Accepted: 02/02/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Expanding access to shorter regimens for tuberculosis (TB) prevention, such as once-weekly isoniazid and rifapentine taken for 3 months (3HP), is critical for reducing global TB burden among people living with HIV (PLHIV). Our coprimary hypotheses were that high levels of acceptance and completion of 3HP could be achieved with delivery strategies optimized to overcome well-contextualized barriers and that 3HP acceptance and completion would be highest when PLHIV were provided an informed choice between delivery strategies. METHODS AND FINDINGS In a pragmatic, single-center, 3-arm, parallel-group randomized trial, PLHIV receiving care at a large urban HIV clinic in Kampala, Uganda, were randomly assigned (1:1:1) to receive 3HP by facilitated directly observed therapy (DOT), facilitated self-administered therapy (SAT), or informed choice between facilitated DOT and facilitated SAT using a shared decision-making aid. We assessed the primary outcome of acceptance and completion (≥11 of 12 doses of 3HP) within 16 weeks of treatment initiation using proportions with exact binomial confidence intervals (CIs). We compared proportions between arms using Fisher's exact test (two-sided α = 0.025). Trial investigators were blinded to primary and secondary outcomes by study arm. Between July 13, 2020, and July 8, 2022, 1,656 PLHIV underwent randomization, with equal numbers allocated to each study arm. One participant was erroneously enrolled a second time and was excluded in the primary intention-to-treat analysis. Among the remaining 1,655 participants, the proportion who accepted and completed 3HP exceeded the prespecified 80% target in the DOT (0.94; 97.5% CI [0.91, 0.96] p < 0.001), SAT (0.92; 97.5% CI [0.89, 0.94] p < 0.001), and Choice (0.93; 97.5% CI [0.91, 0.96] p < 0.001) arms. There was no difference in acceptance and completion between any 2 arms overall or in prespecified subgroup analyses based on sex, age, time on antiretroviral therapy, and history of prior treatment for TB or TB infection. Only 14 (0.8%) participants experienced an adverse event prompting discontinuation of 3HP. The main limitation of the study is that it was conducted in a single center. Multicenter studies are now needed to confirm the feasibility and generalizability of the facilitated 3HP delivery strategies in other settings. CONCLUSIONS Short-course TB preventive treatment was widely accepted by PLHIV in Uganda, and very high levels of treatment completion were achieved in a programmatic setting with delivery strategies tailored to address known barriers. TRIAL REGISTRATION ClinicalTrials.gov NCT03934931.
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Affiliation(s)
- Fred C. Semitala
- Makerere University, Department of Medicine, College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Makerere University Joint AIDS Program, Kampala Uganda
| | - Jillian L. Kadota
- Center for Tuberculosis, University of California San Francisco, San Francisco, California, United States of America
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | | | - Fred Welishe
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Anne Nakitende
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Lydia Akello
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Jane Nakimuli
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Opira Bishop
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Suzan Nakasendwa
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Yeonsoo Baik
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Devika Patel
- The Better Lab and Department of Surgery, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Amanda Sammann
- The Better Lab and Department of Surgery, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Payam Nahid
- Center for Tuberculosis, University of California San Francisco, San Francisco, California, United States of America
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Robert Belknap
- Denver Health and Hospital Authority and Division of Infectious Diseases, Department of Medicine, University of Colorado, Denver, Colorado, United States of America
| | - Moses R. Kamya
- Makerere University, Department of Medicine, College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Margaret A. Handley
- Center for Vulnerable Populations, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Patrick PJ Phillips
- Center for Tuberculosis, University of California San Francisco, San Francisco, California, United States of America
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Anne Katahoire
- Child Health and Development Center, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Christopher A. Berger
- Center for Tuberculosis, University of California San Francisco, San Francisco, California, United States of America
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Noah Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Achilles Katamba
- Clinical Epidemiology & Biostatistics Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
| | - David W. Dowdy
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Adithya Cattamanchi
- Center for Tuberculosis, University of California San Francisco, San Francisco, California, United States of America
- Uganda Tuberculosis Implementation Research Consortium, Walimu, Kampala, Uganda
- Division of Pulmonary Diseases and Critical Care Medicine, University of California Irvine, Irvine, California, United States of America
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Wang L, Wang H, Yan L, Yu M, Yang J, Li J, Li J, Ning Y, Jiang H, Shi Y, Zhang W, Xiong L, Liu J, Kuang Y, Wang H, He J, Wang D, Li B, Liu Y, Shui T, Wang Y, Chen H, Sha X, Long H, Yu X, Shen C, Shen J, Yang X, Gu H, Zhang G, Wang B. Single-Dose Rifapentine in Household Contacts of Patients with Leprosy. N Engl J Med 2023; 388:1843-1852. [PMID: 37195940 DOI: 10.1056/nejmoa2205487] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Previous studies have suggested that a single dose of rifampin has protective effects against leprosy in close contacts of patients with the disease. Rifapentine was shown to have greater bactericidal activity against Mycobacterium leprae than rifampin in murine models of leprosy, but data regarding its effectiveness in preventing leprosy are lacking. METHODS We conducted a cluster-randomized, controlled trial to investigate whether single-dose rifapentine is effective in preventing leprosy in household contacts of patients with leprosy. The clusters (counties or districts in Southwest China) were assigned to one of three trial groups: single-dose rifapentine, single-dose rifampin, or control (no intervention). The primary outcome was the 4-year cumulative incidence of leprosy among household contacts. RESULTS A total of 207 clusters comprising 7450 household contacts underwent randomization; 68 clusters (2331 household contacts) were assigned to the rifapentine group, 71 (2760) to the rifampin group, and 68 (2359) to the control group. A total of 24 new cases of leprosy occurred over the 4-year follow-up, for a cumulative incidence of 0.09% (95% confidence interval [CI], 0.02 to 0.34) with rifapentine (2 cases), 0.33% (95% CI, 0.17 to 0.63) with rifampin (9 cases), and 0.55% (95% CI, 0.32 to 0.95) with no intervention (13 cases). In an intention-to-treat analysis, the cumulative incidence in the rifapentine group was 84% lower than that in the control group (cumulative incidence ratio, 0.16; multiplicity-adjusted 95% CI, 0.03 to 0.87; P = 0.02); the cumulative incidence did not differ significantly between the rifampin group and the control group (cumulative incidence ratio, 0.59; multiplicity-adjusted 95% CI, 0.22 to 1.57; P = 0.23). In a per-protocol analysis, the cumulative incidence was 0.05% with rifapentine, 0.19% with rifampin, and 0.63% with no intervention. No severe adverse events were observed. CONCLUSIONS The incidence of leprosy among household contacts over 4 years was lower with single-dose rifapentine than with no intervention. (Funded by the Ministry of Health of China and the Chinese Academy of Medical Sciences; Chinese Clinical Trial Registry number, ChiCTR-IPR-15007075.).
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Affiliation(s)
- Le Wang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Hongsheng Wang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Liangbin Yan
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Meiwen Yu
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Jun Yang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Jinlan Li
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Junhua Li
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Yong Ning
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Haiqin Jiang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Ying Shi
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Wenyue Zhang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Li Xiong
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Jie Liu
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Yanfei Kuang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Hao Wang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Jun He
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - De Wang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Bin Li
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Yangying Liu
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Tiejun Shui
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Ying Wang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Huan Chen
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Xiaowei Sha
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Heng Long
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Xiaojin Yu
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Chong Shen
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Jianping Shen
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Xueyuan Yang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Heng Gu
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Guocheng Zhang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
| | - Baoxi Wang
- From the Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Leprosy Control, Chinese Center for Disease Control and Prevention (CDC) (L.W., Hongsheng Wang, L.Y., M.Y., H.J., Y.S., W.Z., J.S., X. Yang, H.G., G.Z., B.W.), Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, and Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections (Hongsheng Wang), the Department of Epidemiology and Health Statistics, School of Public Health, Southeast University (X. Yu), and the Department of Epidemiology, School of Public Health, Nanjing Medical University (C.S.), Nanjing, Yunnan Provincial CDC, Kunming (J.Y., L.X., J.H., T.S.), Guizhou Provincial CDC, Guiyang (Jinlan Li, J. Liu, D.W., Y.W.), Hunan Provincial CDC, Changsha (Junhua Li, Y.K., B.L., H.C.), Sichuan Provincial People's Hospital, Chengdu (Y.N., Hao Wang, Y. Liu, X.S.), WenShan Prefecture Institute of Dermatology, Wenshan (H.L.), and Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.W.) - all in China
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Pham MM, Podany AT, Mwelase N, Supparatpinyo K, Mohapi L, Gupta A, Samaneka W, Omoz-Oarhe A, Langat D, Benson CA, Chaisson RE, Swindells S, Fletcher CV. Population Pharmacokinetic Modeling and Simulation of Rifapentine Supports Concomitant Antiretroviral Therapy with Efavirenz and Non-Weight Based Dosing. Antimicrob Agents Chemother 2022; 66:e0238521. [PMID: 35943252 PMCID: PMC9487628 DOI: 10.1128/aac.02385-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/20/2022] [Indexed: 11/20/2022] Open
Abstract
The Brief Rifapentine-Isoniazid Efficacy for TB Prevention/A5279 trial demonstrated a 1-month daily regimen of rifapentine and isoniazid was noninferior to 9 months of isoniazid alone for preventing TB in persons living with HIV (PLWH). Our objective was to evaluate rifapentine pharmacokinetics in trial participants receiving antiretroviral therapy (ART) and perform simulations to compare weight-based rifapentine dosing with a standard, fixed dose. Nonlinear mixed effect modeling was used to estimate rifapentine and 25-desacetyl rifapentine population pharmacokinetic characteristics. The pharmacokinetic model was validated using a nonparametric bootstrap and visual predictive checks. Monte Carlo simulations were performed to compare weight-based and fixed dose regimens. Rifapentine and 25-desacetyl rifapentine concentrations (347 of each; 185 participants) were each described with a one-compartment model with one-way conversion between rifapentine and 25-desacetyl rifapentine. The absorption rate was nearly doubled in fed versus fasting states. Rifapentine clearance was increased 31% in those receiving efavirenz (EFV)-based versus nevirapine-based ART. Metabolite clearance was allometrically scaled with fat-free mass. Simulations showed lower rifapentine exposures with weight-based compared with fixed dosing. With 10 mg/kg weight-based regimens, 26% and 62% of simulated exposures in <35 kg and 35-45 kg weight classes were above target (AUC0 to 24 h of 257 mg*hr/L); 85% of simulated exposures across all weight classes with fixed dosing were above target. These data support fixed dosing with rifapentine 600 mg daily for TB prevention regardless of weight for PLWH 13 years or older receiving the 4-week regimen and no need for dose adjustment when given with EFV-based ART. Clinical Trials Registration. NCT01404312.
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Affiliation(s)
- Michelle M. Pham
- Antiviral Pharmacology Laboratory, UNMC Center for Drug Discovery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Anthony T. Podany
- Antiviral Pharmacology Laboratory, UNMC Center for Drug Discovery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Noluthando Mwelase
- University of the Witwatersrand Helen Joseph CRS, Johannesburg, South Africa
| | | | - Lerato Mohapi
- Soweto ACTG CRS, Perinatal HIV Research Unit, Johannesburg, South Africa
| | - Amita Gupta
- Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | | | - Deborah Langat
- Kenya Medical Research Institute/Walter Reed Project Clinical Research Center CRS, Kericho, Kenya
| | | | - Richard E. Chaisson
- Johns Hopkins University School of Medicine, Center for Tuberculosis Research, Baltimore, Maryland, USA
| | - Susan Swindells
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Courtney V. Fletcher
- Antiviral Pharmacology Laboratory, UNMC Center for Drug Discovery, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Sharan R, Ganatra SR, Singh DK, Cole J, Foreman TW, Thippeshappa R, Peloquin CA, Shivanna V, Gonzalez O, Day CL, Gandhi NR, Dick EJ, Hall-Ursone S, Mehra S, Schlesinger LS, Rengarajan J, Kaushal D. Isoniazid and rifapentine treatment effectively reduces persistent M. tuberculosis infection in macaque lungs. J Clin Invest 2022; 132:e161564. [PMID: 35862216 PMCID: PMC9479578 DOI: 10.1172/jci161564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/19/2022] [Indexed: 02/01/2023] Open
Abstract
A once-weekly oral dose of isoniazid and rifapentine for 3 months (3HP) is recommended by the CDC for treatment of latent tuberculosis infection (LTBI). The aim of this study is to assess 3HP-mediated clearance of M. tuberculosis bacteria in macaques with asymptomatic LTBI. Twelve Indian-origin rhesus macaques were infected with a low dose (~10 CFU) of M. tuberculosis CDC1551 via aerosol. Six animals were treated with 3HP and 6 were left untreated. The animals were imaged via PET/CT at frequent intervals. Upon treatment completion, all animals except 1 were coinfected with SIV to assess reactivation of LTBI to active tuberculosis (ATB). Four of 6 treated macaques showed no evidence of persistent bacilli or extrapulmonary spread until the study end point. PET/CT demonstrated the presence of significantly more granulomas in untreated animals relative to the treated group. The untreated animals harbored persistent bacilli and demonstrated tuberculosis (TB) reactivation following SIV coinfection, while none of the treated animals reactivated to ATB. 3HP treatment effectively reduced persistent infection with M. tuberculosis and prevented reactivation of TB in latently infected macaques.
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Affiliation(s)
- Riti Sharan
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Shashank R. Ganatra
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Dhiraj K. Singh
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Journey Cole
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Taylor W. Foreman
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Rajesh Thippeshappa
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | | | - Vinay Shivanna
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Olga Gonzalez
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | | | - Neel R. Gandhi
- Emory Tuberculosis Center and
- Emory Vaccine Center, Emory National Primate Research Center, Emory University, Atlanta, Georgia, USA
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Edward J. Dick
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Shannan Hall-Ursone
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Smriti Mehra
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Larry S. Schlesinger
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Jyothi Rengarajan
- Emory Tuberculosis Center and
- Emory Vaccine Center, Emory National Primate Research Center, Emory University, Atlanta, Georgia, USA
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Deepak Kaushal
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, USA
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Podany AT, Pham M, Sizemore E, Martinson N, Samaneka W, Mohapi L, Badal-Faesen S, Dawson R, Johnson JL, Mayanja H, Lalloo U, Whitworth WC, Pettit A, Campbell K, Phillips PPJ, Bryant K, Scott N, Vernon A, Kurbatova EV, Chaisson RE, Dorman SE, Nahid P, Swindells S, Dooley KE, Fletcher CV. Efavirenz Pharmacokinetics and Human Immunodeficiency Virus Type 1 (HIV-1) Viral Suppression Among Patients Receiving Tuberculosis Treatment Containing Daily High-Dose Rifapentine. Clin Infect Dis 2022; 75:560-566. [PMID: 34918028 PMCID: PMC9890454 DOI: 10.1093/cid/ciab1037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND A 4-month regimen containing rifapentine and moxifloxacin has noninferior efficacy compared to the standard 6-month regimen for drug-sensitive tuberculosis. We evaluated the effect of regimens containing daily, high-dose rifapentine on efavirenz pharmacokinetics and viral suppression in patients with human immunodeficiency virus (HIV)-associated tuberculosis (TB). METHODS In the context of a Phase 3 randomized controlled trial, HIV-positive individuals already virally suppressed on efavirenz--containing antiretroviral therapy (ART) (EFV1), or newly initiating efavirenz (EFV2) received TB treatment containing rifapentine (1200 mg), isoniazid, pyrazinamide, and either ethambutol or moxifloxacin. Mid-interval efavirenz concentrations were measured (a) during ART and TB cotreatment (Weeks 4, 8, 12, and 17, different by EFV group) and (b) when ART was taken alone (pre- or post-TB treatment, Weeks 0 and 22). Apparent oral clearance (CL/F) was estimated and compared. Target mid-interval efavirenz concentrations were > 1 mg/L. Co-treatment was considered acceptable if > 80% of participants had mid-interval efavirenz concentrations meeting this target. RESULTS EFV1 and EFV2 included 70 and 41 evaluable participants, respectively. The geometric mean ratio comparing efavirenz CL/F with vs without TB drugs was 0.79 (90% confidence interval [CI] .72-.85) in EFV1 and 0.84 [90% CI .69-.97] in EFV2. The percent of participants with mid-interval efavirenz concentrations > 1mg/L in EFV1 at Weeks 0, 4, 8, and 17 was 96%, 96%, 88%, and 89%, respectively. In EFV2, at approximately 4 and 8 weeks post efavirenz initiation, the value was 98%. CONCLUSIONS TB treatment containing high-dose daily rifapentine modestly decreased (rather than increased) efavirenz clearance and therapeutic targets were met supporting the use of efavirenz with these regimens, without dose adjustment. CLINICAL TRIALS REGISTRATION NCT02410772.
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Affiliation(s)
| | - Michelle Pham
- University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Erin Sizemore
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Neil Martinson
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | | | - Lerato Mohapi
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | | | - Rod Dawson
- University of Cape Town Lung Institute, Cape Town, South Africa
| | | | - Harriet Mayanja
- Uganda- Case Western Reserve University Research Collaboration, Kampala, Uganda
| | - Umesh Lalloo
- Durban International Clinical Research Site, Durban, South Africa
| | | | - April Pettit
- Vanderbilt University, Nashville, Tennessee, USA
| | - Kayla Campbell
- University of Nebraska Medical Center, Omaha, Nebraska, USA
- University of Colorado, Denver, Colorado, USA
| | - Patrick P J Phillips
- University of California, San Francisco Center for Tuberculosis, San Francisco, California, USA
| | - Kia Bryant
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nigel Scott
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andrew Vernon
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Susan E Dorman
- Medical University of South Carolina, Columbia, South Carolina, USA
| | - Payam Nahid
- University of California, San Francisco Center for Tuberculosis, San Francisco, California, USA
| | | | - Kelly E Dooley
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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7
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Mkhize B, Kellermann T, Norman J, Castel S, Joubert A, van der Merwe M, Dooley KE, Mathad JS, Wiesner L. Validation and application of a quantitative liquid chromatography tandem mass spectrometry assay for the analysis of rifapentine and 25-O-desacetyl rifapentine in human milk. J Pharm Biomed Anal 2022; 215:114774. [PMID: 35462285 PMCID: PMC9871952 DOI: 10.1016/j.jpba.2022.114774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/28/2022] [Accepted: 04/14/2022] [Indexed: 01/27/2023]
Abstract
A robust analytical method based on liquid chromatography coupled to tandem mass spectrometry was developed and validated to quantify rifapentine and 25-O-desacetyl rifapentine in human breast milk to aid in determining the breastfed infant risk to the excreted drug in human milk. Samples were extracted by a combination of protein precipitation and solid phase extraction using rifampicin-d3 as an internal standard. An Agilent® Poroshell 120 EC-C18 (4.6 mm × 50 mm, 2.7 µm) column was used for chromatographic separation employing an isocratic mobile phase consisting of acetonitrile: methanol: 0.1% formic acid (55/5/40, v/v/v) at a flow rate of 450 µL/min, and with a total run time of four minutes. Mass detection was on an AB Sciex API 4000 mass spectrometer using electrospray ionization in the positive mode and based on multiple reaction monitoring data acquisition. Rifapentine was accurately quantified across a concentration range of 2.00-2000 ng/mL and 25-O-desacetyl rifapentine from 4.00 to 2000 ng/mL. During validation, the inter- and intra-day accuracy and precision at the tested QC concentrations (N = 18) for rifapentine were between 97.4% and 100.6%, and 3.1% and 8.3%, respectively. The inter- and intra-day accuracy and precision for 25-O-desacetyl rifapentine were between 96.4% and 106.3%, and 6.7% and 11.8%, respectively. No significant matrix effects were observed, and the method was shown to be specific for rifapentine and 25-O-desacetyl rifapentine. Human milk samples (N = 22) generated during a phase I/II clinical trial were successfully analysed for rifapentine and 25-O-desacetyl rifapentine using this validated method. Concentrations for rifapentine and 25-O-desacetyl rifapentine in human milk samples (N = 22) ranged from 11.2-1180 ng/mL and 7.11-573 ng/mL, respectively.
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Affiliation(s)
- Buyisile Mkhize
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Tracy Kellermann
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Division of Clinical Pharmacology, Department of Medicine, Stellenbosch University, Cape Town, South Africa
| | - Jennifer Norman
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Sandra Castel
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Anton Joubert
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Marthinus van der Merwe
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Kelly E Dooley
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jyoti S Mathad
- Department of Medicine and Obstetrics and Gynecology, Center for Global Health, Weill Cornell Medicine, New York, NY, USA
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
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Taylor A, Woodrow C. Four-Month Rifapentine Regimens for Tuberculosis. N Engl J Med 2022; 386:1095-1096. [PMID: 35294822 DOI: 10.1056/nejmc2114483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Andrew Taylor
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Charles Woodrow
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
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9
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Marzolini C, Gibbons S, van Oosterhout JJ, Khoo S. Drug-Drug Interaction Potential with Once-Weekly Isoniazid/Rifapentine (3HP) for the Treatment of Latent Tuberculosis Infection. Clin Pharmacokinet 2022; 61:339-346. [PMID: 34905153 DOI: 10.1007/s40262-021-01098-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Catia Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital of Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
| | - Sara Gibbons
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Joep J van Oosterhout
- Partners in Hope, Lilongwe, Malawi
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Saye Khoo
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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10
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Egorova A, Salina EG, Makarov V. Targeting Non-Replicating Mycobacterium tuberculosis and Latent Infection: Alternatives and Perspectives (Mini-Review). Int J Mol Sci 2021; 22:ijms222413317. [PMID: 34948114 PMCID: PMC8707483 DOI: 10.3390/ijms222413317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 01/02/2023] Open
Abstract
Latent tuberculosis infection (LTBI) represents a major challenge to curing TB disease. Current guidelines for LTBI management include only three older drugs and their combinations-isoniazid and rifamycins (rifampicin and rifapentine). These available control strategies have little impact on latent TB elimination, and new specific therapeutics are urgently needed. In the present mini-review, we highlight some of the alternatives that may potentially be included in LTBI treatment recommendations and a list of early-stage prospective small molecules that act on drug targets specific for Mycobacterium tuberculosis latency.
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Affiliation(s)
- Anna Egorova
- The Federal Research Centre “Fundamentals of Biotechnology” of the Russian Academy of Sciences (Research Center of Biotechnology RAS), 119071 Moscow, Russia; (A.E.); (E.G.S.)
| | - Elena G. Salina
- The Federal Research Centre “Fundamentals of Biotechnology” of the Russian Academy of Sciences (Research Center of Biotechnology RAS), 119071 Moscow, Russia; (A.E.); (E.G.S.)
- Department of Biology and Biotechnology “Lazzaro Spallanzani”, University of Pavia, 27100 Pavia, Italy
| | - Vadim Makarov
- The Federal Research Centre “Fundamentals of Biotechnology” of the Russian Academy of Sciences (Research Center of Biotechnology RAS), 119071 Moscow, Russia; (A.E.); (E.G.S.)
- Correspondence:
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Semitala FC, Kadota JL, Musinguzi A, Nabunje J, Welishe F, Nakitende A, Akello L, Bishop O, Patel D, Sammann A, Nahid P, Belknap R, Kamya MR, Handley MA, Phillips PPJ, Katahoire A, Berger CA, Kiwanuka N, Katamba A, Dowdy DW, Cattamanchi A. Completion of isoniazid-rifapentine (3HP) for tuberculosis prevention among people living with HIV: Interim analysis of a hybrid type 3 effectiveness-implementation randomized trial. PLoS Med 2021; 18:e1003875. [PMID: 34914696 PMCID: PMC8726462 DOI: 10.1371/journal.pmed.1003875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/04/2022] [Accepted: 11/25/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Scaling up shorter regimens for tuberculosis (TB) prevention such as once weekly isoniazid-rifapentine (3HP) taken for 3 months is a key priority for achieving targets set forth in the World Health Organization's (WHO) END TB Strategy. However, there are few data on 3HP patient acceptance and completion in the context of routine HIV care in sub-Saharan Africa. METHODS AND FINDINGS The 3HP Options Trial is a pragmatic, parallel type 3 effectiveness-implementation randomized trial comparing 3 optimized strategies for delivering 3HP-facilitated directly observed therapy (DOT), facilitated self-administered therapy (SAT), or informed choice between DOT and SAT using a shared decision-making aid-to people receiving care at a large urban HIV clinic in Kampala, Uganda. Participants and healthcare providers were not blinded to arm assignment due to the nature of the 3HP delivery strategies. We conducted an interim analysis of participants who were enrolled and exited the 3HP treatment period between July 13, 2020 and April 30, 2021. The primary outcome, which was aggregated across trial arms for this interim analysis, was the proportion who accepted and completed 3HP (≥11 of 12 doses within 16 weeks of randomization). We used Bayesian inference analysis to estimate the posterior probability that this proportion would exceed 80% under at least 1 of the 3HP delivery strategies, a coprimary hypothesis of the trial. Through April 2021, 684 participants have been enrolled, and 479 (70%) have exited the treatment period. Of these 479 participants, 309 (65%) were women, mean age was 41.9 years (standard deviation (SD): 9.2), and mean time on antiretroviral therapy (ART) was 7.8 years (SD: 4.3). In total, 445 of them (92.9%, 95% confidence interval (CI): [90.2 to 94.9]) accepted and completed 3HP treatment. There were no differences in treatment acceptance and completion by sex, age, or time on ART. Treatment was discontinued due to a documented adverse event (AE) in 8 (1.7%) patients. The probability that treatment acceptance and completion exceeds 80% under at least 1 of the three 3HP delivery strategies was greater than 99%. The main limitations are that the trial was conducted at a single site, and the interim analysis focused on aggregate outcome data to maintain blinding of investigators to arm-specific outcomes. CONCLUSIONS 3HP was widely accepted by people living with HIV (PLHIV) in Uganda, and very high levels of treatment completion were achieved in a programmatic setting. These findings show that 3HP can enable effective scale-up of tuberculosis preventive therapy (TPT) in high-burden countries, particularly when delivery strategies are tailored to target known barriers to treatment completion. TRIAL REGISTRATION ClinicalTrials.gov NCT03934931.
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Affiliation(s)
- Fred C. Semitala
- Makerere University, Department of Medicine, College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Makerere University Joint AIDS Program, Kampala, Uganda
| | - Jillian L. Kadota
- UCSF Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, California, United States of America
| | | | - Juliet Nabunje
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Fred Welishe
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Anne Nakitende
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Lydia Akello
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Opira Bishop
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Devika Patel
- The Better Lab, Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Amanda Sammann
- The Better Lab, Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Payam Nahid
- UCSF Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, California, United States of America
| | - Robert Belknap
- Denver Health and Hospital Authority and Division of Infectious Diseases, Department of Medicine, University of Colorado, Denver, Colorado, United States of America
| | - Moses R. Kamya
- Makerere University, Department of Medicine, College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Margaret A. Handley
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Patrick P. J. Phillips
- UCSF Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, California, United States of America
| | - Anne Katahoire
- Child Health and Development Center, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Christopher A. Berger
- UCSF Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, California, United States of America
| | - Noah Kiwanuka
- Clinical Epidemiology & Biostatistics Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Achilles Katamba
- Clinical Epidemiology & Biostatistics Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - David W. Dowdy
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Adithya Cattamanchi
- UCSF Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, California, United States of America
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
- * E-mail:
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12
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Tseng SY, Huang YS, Chang TE, Perng CL, Huang YH. Hepatotoxicity, efficacy and completion rate between 3 months of isoniazid plus rifapentine and 9 months of isoniazid in treating latent tuberculosis infection: A systematic review and meta-analysis. J Chin Med Assoc 2021; 84:993-1000. [PMID: 34747900 DOI: 10.1097/jcma.0000000000000605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The mainstay therapy for latent tuberculosis infection is a 9-month regimen of daily isoniazid (9H) and a 3-month regimen of 12 once-weekly doses of isoniazid and rifapentine (3HP). We performed this updated meta-analysis to compare hepatotoxicity, efficacy and completion rate between these two regimens. METHODS We searched all literature in the major medical databases using the subject search terms "isoniazid" and "rifapentine", and performed a systemic review and meta-analysis. RESULTS A total of 14 studies were eligible for the meta-analysis, which included 5600 (49%) patients who received the 3HP regimen and 5919 (51%) patients who received the 9H regimen. A total of 202 (2%) patients had a drug-induced liver injury (DILI) and 11 317 (98%) did not. The pooled odds ratio (OR) of DILI in the 3HP regimen was 0.18 (95% confidence interval [CI], 0.12-0.26; p < 0.0001), compared with the 9H regimen. This result remained consistent in subgroup analyses of ethnicity and study design. The 3HP regimen was superior to the 9H regimen in the prevention of active tuberculosis (OR, 0.38, 95% CI, 0.18-0.80, p = 0.01). Furthermore, the 3HP regimen was associated with a better completion rate than the 9H regimen (OR: 2.30, 95% CI, 2.10-2.53, p < 0.0001). CONCLUSION The 3HP regimen is superior to the 9H regimen, with less hepatotoxicity, and better efficacy and completion rate in treating latent tuberculosis infection.
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Affiliation(s)
- Shao-Yu Tseng
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, and National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
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13
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Yuen CM, Majidulla A, Jaswal M, Safdar N, Malik AA, Khan AJ, Becerra MC, Keshavjee S, Lu C, Hussain H. Cost of Delivering 12-Dose Isoniazid and Rifapentine Versus 6 Months of Isoniazid for Tuberculosis Infection in a High-Burden Setting. Clin Infect Dis 2021; 73:e1135-e1141. [PMID: 33289039 PMCID: PMC8423476 DOI: 10.1093/cid/ciaa1835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Successful delivery and completion of tuberculosis preventive treatment are necessary for tuberculosis elimination. Shorter preventive treatment regimens currently have higher medication costs, but patients spend less time in care and are more likely to complete treatment. It is unknown how economic costs of successful delivery differ between longer and shorter regimens in high-tuberculosis-burden settings. METHODS We developed survey instruments to collect costs from program and patient sources, considering costs incurred from when household contacts first entered the health system. We compared the cost per completed course of preventive treatment with either 6 months of daily isoniazid (6H) or 3 months of weekly isoniazid and rifapentine (3HP), delivered by the Indus Health Network tuberculosis program in Karachi, Pakistan, between October 2016 and February 2018. RESULTS During this period, 459 individuals initiated 6H and 643 initiated 3HP; 39% and 61% completed treatment, respectively. Considering costs to both the program and care recipients, the cost per completed course was 394 US dollars (USD) for 6H and 333 USD for 3HP. Using a new 2020 price for rifapentine reduced the cost per completed course of 3HP to 290 USD. Under varying assumptions about drug prices and costs incurred by care recipients, the cost per completed course was lower for 3HP in all scenarios, and the largest cost drivers were the salaries of clinical staff. CONCLUSIONS In a high-burden setting, the cost of successful delivery of 3HP was lower than that of 6H, driven by higher completion.
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Affiliation(s)
- Courtney M Yuen
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Medical School Center for Global Health Delivery, Boston, Massachusetts, USA
| | | | - Maria Jaswal
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - Nauman Safdar
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | - Amyn A Malik
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
- Interactive Research and Development (IRD) Global, Singapore
| | - Aamir J Khan
- Harvard Medical School Center for Global Health Delivery, Boston, Massachusetts, USA
- Interactive Research and Development (IRD) Global, Singapore
| | - Mercedes C Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Medical School Center for Global Health Delivery, Boston, Massachusetts, USA
| | - Salmaan Keshavjee
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Medical School Center for Global Health Delivery, Boston, Massachusetts, USA
| | - Chunling Lu
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Hamidah Hussain
- Interactive Research and Development (IRD) Global, Singapore
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Yang H, Yang Y, Hu ZD, Xia L, Liu XH, Yu X, Ma JY, Li T, Lu SH. High rate of completion for weekly rifapentine plus isoniazid treatment in Chinese children with latent tuberculosis infection-A single center study. PLoS One 2021; 16:e0253159. [PMID: 34115804 PMCID: PMC8195436 DOI: 10.1371/journal.pone.0253159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/28/2021] [Indexed: 11/24/2022] Open
Abstract
Three months of weekly rifapentine plus isoniazid (3HP) is a short course regimen for latent tuberculosis infection treatment with satisfied safety and efficacy. However, research on its use in children is limited. In this study, we evaluated the completion rate and safety of the 3HP regimen among children in China. Participants aged 1–14 years receiving 3HP for TB prevention at Shanghai Public Health Clinical Center were followed from December 2019 to November 2020 to evaluate the safety and completion rate of the treatment. Thirty-one children were eligible for inclusion, but five were excluded from the analysis (three were treated with a lower than recommended dose, and two were lost to follow-up). Of the 26 children included in the analysis, the treatment completion rate was 100%. Adverse drug reactions (ADRs) were reported in 38.5% (10/26) of the patients. The most common ADRs were gastrointestinal symptoms (19.2%,5/26), and all ADRs were rated as Grade 1. The 3HP regimen has a high completion rate, and it seems well tolerated in our study population. However, further randomized controlled clinical trial with larger sample size are warranted.
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Affiliation(s)
- Heng Yang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yang Yang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Zhi-dong Hu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Lu Xia
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Xu-hui Liu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Xin Yu
- The Affiliated Infectious Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China
| | - Jia-ye Ma
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Tao Li
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- * E-mail: (TL); (SL)
| | - Shui-hua Lu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- * E-mail: (TL); (SL)
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Pease C, Alvarez G, Mallick R, Patterson M, Finn S, Habis Y, Schwartzman K, Kilabuk E, Mulpuru S, Zwerling A. Cost-effectiveness analysis of 3 months of weekly rifapentine and isoniazid compared to isoniazid monotherapy in a Canadian arctic setting. BMJ Open 2021; 11:e047514. [PMID: 33986067 PMCID: PMC8126298 DOI: 10.1136/bmjopen-2020-047514] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To assess the cost effectiveness of once weekly rifapentine and isoniazid for 12 weeks (3HP) to the current standard care for latent tuberculosis (TB) infection (LTBI) in Iqaluit, Nunavut. DESIGN A cost-effectiveness analysis using a Markov model reflecting local practices for LTBI treatment. SETTING A remote Canadian arctic community with a high incidence of TB. PARTICIPANTS Hypothetical patients with LTBI. INTERVENTIONS The cost effectiveness of 3HP was compared with the existing standard of care in the study region which consists of 9 months of twice weekly isoniazid (9H) given by directly observed therapy. OUTCOME MEASURES Effectiveness was measured in quality-adjusted life years (QALYs) with model parameters were derived from historical programmatic data, a local implementation study of 3HP and published literature. Costs from the perspective of the Nunavut healthcare system were measured in 2019 US dollars and were obtained primarily from local, empirically collected data. Secondary health outcomes included estimated TB cases and TB deaths averted using 3HP versus 9H. One way and probabilistic sensitivity analyses were performed. RESULTS The 3HP regimen was dominant over 9H: costs were lower (US$628 vs US$924/person) and health outcomes slightly improved (20.14 vs 20.13 QALYs/person). In comparison to 9H, 3HP treatment resulted in fewer TB cases (27.89 vs 30.16/1000 persons) and TB deaths (2.29 vs 2.48/1000 persons). 3HP completion, initiation and risk of fatal adverse events were the primary drivers of cost effectiveness. CONCLUSION In a remote Canadian arctic setting, using 3HP instead of 9H for LTBI treatment may result in cost savings and similar or improved health outcomes.
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Affiliation(s)
- Christopher Pease
- Division of Respirology, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Gonzalo Alvarez
- Division of Respirology, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Mike Patterson
- Department of Health, Government of Nunavut, Iqaluit, Nunavut, Canada
| | - Sandy Finn
- Department of Health, Government of Nunavut, Iqaluit, Nunavut, Canada
| | - Yahya Habis
- Deparment of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Kevin Schwartzman
- Montreal Chest Institute, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Elaine Kilabuk
- Department of Internal Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sunita Mulpuru
- Division of Respirology, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alice Zwerling
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Affiliation(s)
- Eric J Rubin
- From the Institute of Infectious Disease and Molecular Medicine and the Department of Pathology, Wellcome Centre for Infectious Diseases Research in Africa, and the South African Medical Research Council, National Health Laboratory Service, University of Cape Town Molecular Mycobacteriology Research Unit, University of Cape Town, Cape Town, South Africa (V.M.)
| | - Valerie Mizrahi
- From the Institute of Infectious Disease and Molecular Medicine and the Department of Pathology, Wellcome Centre for Infectious Diseases Research in Africa, and the South African Medical Research Council, National Health Laboratory Service, University of Cape Town Molecular Mycobacteriology Research Unit, University of Cape Town, Cape Town, South Africa (V.M.)
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Lim RK, Semitala FC, Atuhumuza E, Sabiti L, Namakula-Katende J, Muyindike WR, Kamya MR, Dowdy D, Cattamanchi A. Patient choice improves self-efficacy and intention to complete tuberculosis preventive therapy in a routine HIV program setting in Uganda. PLoS One 2021; 16:e0246113. [PMID: 33539400 PMCID: PMC7861427 DOI: 10.1371/journal.pone.0246113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 01/13/2021] [Indexed: 11/18/2022] Open
Abstract
A 12-dose weekly regimen of rifapentine plus isoniazid (3HP) is recommended for the prevention of active tuberculosis (TB); however, it is unclear whether 3HP should be provided by directly observed therapy (DOT) or self-administered therapy (SAT). In addition, the introduction of patient informed choice between delivery modalities may have a positive impact on factors leading to treatment completion. The authors randomized 252 participants with HIV to a hypothetical scenario of providing preventive therapy by either DOT or an informed choice between DOT and SAT. Out of 104 participants who were randomized to a choice between DOT and SAT, 103 chose therapy by SAT. Participants rated their level of confidence and intention to complete therapy. Compared to those assigned to the DOT scenario, patients assigned to the choice scenario expressed greater confidence and intention to complete preventive therapy. Convenience and travel required to complete 3HP therapy were important factors in deciding between delivery modalities. Those assigned to DOT identified more barriers to completing therapy than those given a choice. Empowering patients to make informed decisions about how they receive TB preventive therapy may improve completion rates.
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Affiliation(s)
- Rachel K. Lim
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fred C. Semitala
- Department of Internal Medicine, Makerere University College of Medicine, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Makerere University Joint AIDS Program, Kampala, Uganda
- * E-mail:
| | - Elly Atuhumuza
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Laban Sabiti
- Makerere University Joint AIDS Program, Kampala, Uganda
| | | | - Winnie R. Muyindike
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Moses R. Kamya
- Department of Internal Medicine, Makerere University College of Medicine, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - David Dowdy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Adithya Cattamanchi
- Curry International Tuberculosis Center and Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, California, United States of America
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Surey J, Stagg HR, Yates TA, Lipman M, White PJ, Charlett A, Muñoz L, Gosce L, Rangaka MX, Francis M, Hack V, Kunst H, Abubakar I. An open label, randomised controlled trial of rifapentine versus rifampicin based short course regimens for the treatment of latent tuberculosis in England: the HALT LTBI pilot study. BMC Infect Dis 2021; 21:90. [PMID: 33478428 PMCID: PMC7818935 DOI: 10.1186/s12879-021-05766-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ending the global tuberculosis (TB) epidemic requires a focus on treating individuals with latent TB infection (LTBI) to prevent future cases. Promising trials of shorter regimens have shown them to be effective as preventative TB treatment, however there is a paucity of data on self-administered treatment completion rates. This pilot trial assessed treatment completion, adherence, safety and the feasibility of treating LTBI in the UK using a weekly rifapentine and isoniazid regimen versus daily rifampicin and isoniazid, both self-administered for 12 weeks. METHODS An open label, randomised, multi-site pilot trial was conducted in London, UK, between March 2015 and January 2017. Adults between 16 and 65 years with LTBI at two TB clinics who were eligible for and agreed to preventative therapy were consented and randomised 1:1 to receive either a weekly combination of rifapentine/isoniazid ('intervention') or a daily combination of rifampicin/isoniazid ('standard'), with both regimens taken for twelve weeks; treatment was self-administered in both arms. The primary outcome, completion of treatment, was self-reported, defined as taking more than 90% of prescribed doses and corroborated by pill counts and urine testing. Adverse events were recorded. RESULTS Fifty-two patients were successfully enrolled. In the intervention arm 21 of 27 patients completed treatment (77.8, 95% confidence interval [CI] 57.7-91.4), compared with 19 of 25 (76.0%, CI 54.9-90.6) in the standard of care arm. There was a similar adverse effect profile between the two arms. CONCLUSION In this pilot trial, treatment completion was comparable between the weekly rifapentine/isoniazid and the daily rifampicin/isoniazid regimens. Additionally, the adverse event profile was similar between the two arms. We conclude that it is safe and feasible to undertake a fully powered trial to determine whether self-administered weekly treatment is superior/non-inferior compared to current treatment. TRIAL REGISTRATION The trial was funded by the NIHR, UK and registered with ISRCTN ( 26/02/2013-No.04379941 ).
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Affiliation(s)
- J Surey
- Institute for Global Health, University College London, London, UK.
- Faculty of Medicine, Universidad Autónoma Madrid, Madrid, Spain.
| | - H R Stagg
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - T A Yates
- Institute for Global Health, University College London, London, UK
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, W2 1NY, UK
| | - M Lipman
- UCL-TB and UCL Respiratory, UCL, London, Royal Free London National Health Service Foundation Trust, London, UK
| | - P J White
- National Infection Service, Public Health, England, UK
- Department of Infectious Disease Epidemiology, Imperial College School of Public Health, MRC Centre for Global Infectious Disease Analysis and NIHR Health Protection Research Unit in Modelling Methodology, London, UK
| | - A Charlett
- National Infection Service, Public Health, England, UK
| | - L Muñoz
- Clinical Sciences Department. School of Medicine, University of Barcelona and Internal Medicine Department, Parc Sanitari Sant Joan de Déu. Sant Boi, Barcelona, Spain
| | - L Gosce
- Institute for Global Health, University College London, London, UK
| | - M X Rangaka
- Institute for Global Health, University College London, London, UK
| | - M Francis
- Institute for Global Health, University College London, London, UK
| | - V Hack
- Institute for Global Health, University College London, London, UK
| | - H Kunst
- Blizard Institute, Queen Mary University of London, London, UK
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - I Abubakar
- Institute for Global Health, University College London, London, UK
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Saravanan P, Dusthackeer VNA, Rajmani RS, Mahizhaveni B, Nirmal CR, Rajadas SE, Bhardwaj N, Ponnuraja C, Bhaskar A, Hemanthkumar AK, Ramachandran G, Tripathy SP. Discovery of a highly potent novel rifampicin analog by preparing a hybrid of the precursors of the antibiotic drugs rifampicin and clofazimine. Sci Rep 2021; 11:1029. [PMID: 33441878 PMCID: PMC7806721 DOI: 10.1038/s41598-020-80439-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/10/2020] [Indexed: 12/26/2022] Open
Abstract
Tuberculosis (TB) is an infectious disease caused by the bacillus Mycobacterium tuberculosis (Mtb). The present work reports the design and synthesis of a hybrid of the precursors of rifampicin and clofazimine, which led to the discovery of a novel Rifaphenazine (RPZ) molecule with potent anti-TB activity. In addition, the efficacy of RPZ was evaluated in-vitro using the reference strain Mtb H37Rv. Herein, 2,3 diamino phenazine, a precursor of an anti-TB drug clofazimine, was tethered to the rifampicin core. This 2,3 diamino phenazine did not have an inherent anti-TB activity even at a concentration of up to 2 µg/mL, while rifampicin did not exhibit any activity against Mtb at a concentration of 0.1 µg/mL. However, the synthesized novel Rifaphenzine (RPZ) inhibited 78% of the Mtb colonies at a drug concentration of 0.1 µg/mL, while 93% of the bacterial colonies were killed at 0.5 µg/mL of the drug. Furthermore, the Minimum Inhibitory Concentration (MIC) value for RPZ was 1 µg/mL. Time-kill studies revealed that all bacterial colonies were killed within a period of 24 h. The synthesized novel molecule was characterized using high-resolution mass spectroscopy and NMR spectroscopy. Cytotoxicity studies (IC50) were performed on human monocytic cell line THP-1, and the determined IC50 value was 96 µg/mL, which is non-cytotoxic.
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Affiliation(s)
| | | | - R S Rajmani
- Centre for Infectious Disease and Research, Indian Institute of Science, Bangalore, India
| | - B Mahizhaveni
- ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Christy R Nirmal
- ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | | | - Neerupma Bhardwaj
- Centre for Infectious Disease and Research, Indian Institute of Science, Bangalore, India
| | - C Ponnuraja
- ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Adhin Bhaskar
- ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - A K Hemanthkumar
- ICMR-National Institute for Research in Tuberculosis, Chennai, India
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20
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Haas DW, Podany AT, Bao Y, Swindells S, Chaisson RE, Mwelase N, Supparatpinyo K, Mohapi L, Gupta A, Benson CA, Baker P, Fletcher CV. Pharmacogenetic interactions of rifapentine plus isoniazid with efavirenz or nevirapine. Pharmacogenet Genomics 2021; 31:17-27. [PMID: 32815870 PMCID: PMC7655626 DOI: 10.1097/fpc.0000000000000417] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The effect of rifapentine plus isoniazid on efavirenz pharmacokinetics was characterized in AIDS Clinical Trials Group protocol A5279 (NCT01404312). The present analyses characterize pharmacogenetic interactions between these drugs, and with nevirapine. METHODS A subset of HIV-positive individuals receiving efavirenz- or nevirapine-containing antiretroviral therapy in A5279 underwent pharmacokinetic evaluations at baseline, and again weeks 2 and 4 after initiating daily rifapentine plus isoniazid. Associations with polymorphisms relevant to efavirenz, nevirapine, isoniazid, and rifapentine pharmacokinetics were assessed. RESULTS Of 128 participants, 101 were evaluable for associations with rifapentine and its active 25-desacetyl metabolite, 87 with efavirenz, and 38 with nevirapine. In multivariable analyses, NAT2 slow acetylators had greater week 4 plasma concentrations of rifapentine (P = 2.6 × 10) and 25-desacetyl rifapentine (P = 7.0 × 10) among all participants, and in efavirenz and nevirapine subgroups. NAT2 slow acetylators also had greater plasma efavirenz and nevirapine concentration increases from baseline to week 4, and greater decreases from baseline in clearance. CYP2B6 poor metabolizers had greater efavirenz concentrations at all weeks and greater nevirapine concentrations at baseline. None of 47 additional polymorphisms in 11 genes were significantly associated with pharmacokinetics. CONCLUSIONS Among HIV-positive individuals receiving efavirenz or nevirapine, and who then initiated rifapentine plus isoniazid in A5279, NAT2 slow acetylators had greater rifapentine and 25-desacetyl rifapentine concentrations, and greater increases from baseline in plasma efavirenz and nevirapine concentrations. These associations are likely mediated by greater isoniazid exposure in NAT2 slow acetylators.
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Affiliation(s)
- David W Haas
- Department of Medicine, Vanderbilt University School of Medicine
| | - Anthony T Podany
- Department of Pharmacy Practice and Science, Antiviral Pharmacology Laboratory, UNMC Center for Drug Discovery, University of Nebraska Medical Center, Omaha
| | - Yajing Bao
- Statistical and Data Analysis Center, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Susan Swindells
- Infectious Diseases, Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Richard E Chaisson
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Noluthando Mwelase
- Helen Joseph Hospital, University of Witwatersrand University, Johannesburg, South Africa
| | - Khuanchai Supparatpinyo
- Department of Medicine, Research Institute for Health Sciences and Faculty of Medicine, Chiang Mai University, Thailand
| | - Lerato Mohapi
- Perinatal HIV Research Unit, University of the Witwatersrand and Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Amita Gupta
- Department of Medicine, Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Constance A Benson
- Departments of Medicine and Global Public Health, Antiviral Research Center, University of California, San Diego
| | - Paxton Baker
- Vanderbilt Technologies for Advanced Genomics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Courtney V Fletcher
- Department of Pharmacy Practice and Science, Antiviral Pharmacology Laboratory, UNMC Center for Drug Discovery, University of Nebraska Medical Center, Omaha; for the AIDS Clinical Trials Group A5279 Study Team
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Parvez MSA, Karim MA, Hasan M, Jaman J, Karim Z, Tahsin T, Hasan MN, Hosen MJ. Prediction of potential inhibitors for RNA-dependent RNA polymerase of SARS-CoV-2 using comprehensive drug repurposing and molecular docking approach. Int J Biol Macromol 2020; 163:1787-1797. [PMID: 32950529 PMCID: PMC7495146 DOI: 10.1016/j.ijbiomac.2020.09.098] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/24/2020] [Accepted: 09/14/2020] [Indexed: 12/24/2022]
Abstract
The pandemic prevalence of COVID-19 has become a very serious global health issue. Scientists all over the world have been seriously attempting in the discovery of a drug to combat SARS-CoV-2. It has been found that RNA-dependent RNA polymerase (RdRp) plays a crucial role in SARS-CoV-2 replication, and thus could be a potential drug target. Here, comprehensive computational approaches including drug repurposing and molecular docking were employed to predict an effective drug candidate targeting RdRp of SARS-CoV-2. This study revealed that Rifabutin, Rifapentine, Fidaxomicin, 7-methyl-guanosine-5'-triphosphate-5'-guanosine and Ivermectin have a potential inhibitory interaction with RdRp of SARS-CoV-2 and could be effective drugs for COVID-19. In addition, virtual screening of the compounds from ZINC database also allowed the prediction of two compounds (ZINC09128258 and ZINC09883305) with pharmacophore features that interact effectively with RdRp of SARS-CoV-2, indicating their potentiality as effective inhibitors of the enzyme. Furthermore, ADME analysis along with analysis of toxicity was also undertaken to check the pharmacokinetics and drug-likeness properties of the two compounds. Comparative structural analysis of protein-inhibitor complexes revealed that the amino acids Y32, K47, Y122, Y129, H133, N138, D140, T141, S709 and N781 are crucial for drug surface hotspot in the RdRp of SARS-CoV-2.
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Affiliation(s)
- Md Sorwer Alam Parvez
- Department of Genetic Engineering & Biotechnology, Shahjalal University of Science & Technology, Sylhet 3114, Bangladesh.
| | - Md Adnan Karim
- Department of Genetic Engineering & Biotechnology, Jashore University of Science & Technology, Jashore, Bangladesh; Center for Bioinformatics, Universitat Des Saarlandes, Saarbrucken, Germany
| | - Mahmudul Hasan
- Department of Pharmaceuticals and Industrial Biotechnology, Sylhet Agricultural University, Sylhet 3100, Bangladesh
| | - Jomana Jaman
- Department of Biotechnology, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Ziaul Karim
- Department of Biology, Chemistry and Pharmacy, Free University of Berlin, Berlin, Germany
| | - Tohura Tahsin
- Department of Genetic Engineering & Biotechnology, Shahjalal University of Science & Technology, Sylhet 3114, Bangladesh
| | - Md Nazmul Hasan
- Department of Genetic Engineering & Biotechnology, Jashore University of Science & Technology, Jashore, Bangladesh
| | - Mohammad Jakir Hosen
- Department of Genetic Engineering & Biotechnology, Shahjalal University of Science & Technology, Sylhet 3114, Bangladesh.
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Lenz SM, Collins JH, Ray NA, Hagge DA, Lahiri R, Adams LB. Post-exposure prophylaxis (PEP) efficacy of rifampin, rifapentine, moxifloxacin, minocycline, and clarithromycin in a susceptible-subclinical model of leprosy. PLoS Negl Trop Dis 2020; 14:e0008583. [PMID: 32936818 PMCID: PMC7494095 DOI: 10.1371/journal.pntd.0008583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/09/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Subclinical infection with Mycobacterium leprae is one potential source of leprosy transmission, and post-exposure prophylaxis (PEP) regimens have been proposed to control this source. Because PEP trials require considerable investment, we applied a sensitive variation of the kinetic mouse footpad (MFP) screening assay to aid in the choice of drugs and regimens for clinical trials. METHODOLOGY/PRINCIPAL FINDINGS Athymic nude mice were inoculated in the footpad (FP) with 6 x 103 viable M. leprae and treated by gastric gavage with a single dose of Rifampin (SDR), Rifampin + Ofloxacin + Minocycline (SD-ROM), or Rifapentine + Minocycline + Moxifloxacin (SD-PMM) or with the proposed PEP++ regimen of three once-monthly doses of Rifampin + Moxifloxacin (RM), Rifampin + Clarithromycin (RC), Rifapentine + Moxifloxacin (PM), or Rifapentine + Clarithromycin (PC). At various times post-treatment, DNA was purified from the FP, and M. leprae were enumerated by RLEP quantitative PCR. A regression analysis was calculated to determine the expected RLEP value if 99.9% of the bacilli were killed after the administration of each regimen. SDR and SD-ROM induced little growth delay in this highly susceptible murine model of subclinical infection. In contrast, SD-PMM delayed measurable M. leprae growth above the inoculum by 8 months. The four multi-dose regimens delayed bacterial growth for >9months post-treatment cessation. CONCLUSIONS/SIGNIFICANCE The delay in discernable M. leprae growth post-treatment was an excellent indicator of drug efficacy for both early (3-4 months) and late (8-9 months) drug efficacy. Our data indicates that multi-dose PEP may be required to control infection in highly susceptible individuals with subclinical leprosy to prevent disease and decrease transmission.
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Affiliation(s)
| | - Jaymes H. Collins
- Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen’s Disease Programs–Laboratory Research Branch, Baton Rouge, Louisiana, United States of America
| | - Nashone A. Ray
- Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen’s Disease Programs–Laboratory Research Branch, Baton Rouge, Louisiana, United States of America
| | - Deanna A. Hagge
- Mycobacterial Research Laboratories, Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal
| | - Ramanuj Lahiri
- Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen’s Disease Programs–Laboratory Research Branch, Baton Rouge, Louisiana, United States of America
| | - Linda B. Adams
- Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, National Hansen’s Disease Programs–Laboratory Research Branch, Baton Rouge, Louisiana, United States of America
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23
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Chauffour A, Robert J, Veziris N, Aubry A, Pethe K, Jarlier V. Telacebec (Q203)-containing intermittent oral regimens sterilized mice infected with Mycobacterium ulcerans after only 16 doses. PLoS Negl Trop Dis 2020; 14:e0007857. [PMID: 32866170 PMCID: PMC7494103 DOI: 10.1371/journal.pntd.0007857] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 09/16/2020] [Accepted: 06/15/2020] [Indexed: 11/28/2022] Open
Abstract
Buruli ulcer (BU), caused by Mycobacterium ulcerans, is currently treated with a daily combination of rifampin and either injectable streptomycin or oral clarithromycin. An intermittent oral regimen would facilitate treatment supervision. We first evaluated the bactericidal activity of newer antimicrobials against M. ulcerans using a BU animal model. The imidazopyridine amine telacebec (Q203) exhibited high bactericidal activity whereas tedizolid (an oxazolidinone closely related to linezolid), selamectin and ivermectin (two avermectine compounds) and the benzothiazinone PBTZ169 were not active. Consequently, telacebec was evaluated for its bactericidal and sterilizing activities in combined intermittent regimens. Telacebec given twice a week in combination with a long-half-life compound, either rifapentine or bedaquiline, sterilized mouse footpads in 8 weeks, i.e. after a total of only 16 doses, and prevented relapse during a period of 20 weeks after the end of treatment. These results are very promising for future intermittent oral regimens which would greatly simplify BU treatment in the field. The current treatment for Buruli ulcer (BU), an infection caused by Mycobacterium ulcerans, is based on a daily antibiotic combination of rifampin associated with streptomycin or clarithromycin. A shorter or intermittent treatment without an injectable drug would clearly simplify the management in the field. We evaluated the bactericidal activity of several new antimicrobial drugs in a mouse model of BU and found that telacebec (Q203) exhibited the greatest bactericidal effect. We subsequently identified new antibiotic combinations containing telacebec with high sterilizing activity when administered twice a week for 8 weeks, i.e. at a total of only 16 doses.
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Affiliation(s)
- Aurélie Chauffour
- Sorbonne Université, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
- * E-mail:
| | - Jérôme Robert
- Sorbonne Université, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Laboratoire de Bactériologie-Hygiène, Groupe hospitalier APHP, Sorbonne Université, Site Pitié-Salpêtrière, Paris, France
| | - Nicolas Veziris
- Sorbonne Université, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Laboratoire de Bactériologie-Hygiène, Groupe hospitalier APHP, Sorbonne Université, Site Pitié-Salpêtrière, Paris, France
- Département de Bactériologie, Groupe hospitalier APHP, Sorbonne Université, Site Saint-Antoine, Paris, France
| | - Alexandra Aubry
- Sorbonne Université, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Laboratoire de Bactériologie-Hygiène, Groupe hospitalier APHP, Sorbonne Université, Site Pitié-Salpêtrière, Paris, France
| | - Kevin Pethe
- Lee Kong Chian School of Medicine, Nanyang Technological University, Experimental Medicine Building, Singapore, Singapore
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Vincent Jarlier
- Sorbonne Université, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Laboratoire de Bactériologie-Hygiène, Groupe hospitalier APHP, Sorbonne Université, Site Pitié-Salpêtrière, Paris, France
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Dorman SE, Nahid P, Kurbatova EV, Goldberg SV, Bozeman L, Burman WJ, Chang KC, Chen M, Cotton M, Dooley KE, Engle M, Feng PJ, Fletcher CV, Ha P, Heilig CM, Johnson JL, Lessem E, Metchock B, Miro JM, Nhung NV, Pettit AC, Phillips PPJ, Podany AT, Purfield AE, Robergeau K, Samaneka W, Scott NA, Sizemore E, Vernon A, Weiner M, Swindells S, Chaisson RE. High-dose rifapentine with or without moxifloxacin for shortening treatment of pulmonary tuberculosis: Study protocol for TBTC study 31/ACTG A5349 phase 3 clinical trial. Contemp Clin Trials 2020; 90:105938. [PMID: 31981713 PMCID: PMC7307310 DOI: 10.1016/j.cct.2020.105938] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Phase 2 clinical trials of tuberculosis treatment have shown that once-daily regimens in which rifampin is replaced by high dose rifapentine have potent antimicrobial activity that may be sufficient to shorten overall treatment duration. Herein we describe the design of an ongoing phase 3 clinical trial testing the hypothesis that once-daily regimens containing high dose rifapentine in combination with other anti-tuberculosis drugs administered for four months can achieve cure rates not worse than the conventional six-month treatment regimen. METHODS/DESIGN S31/A5349 is a multicenter randomized controlled phase 3 non-inferiority trial that compares two four-month regimens with the standard six-month regimen for treating drug-susceptible pulmonary tuberculosis in HIV-negative and HIV-positive patients. Both of the four-month regimens contain high-dose rifapentine instead of rifampin, with ethambutol replaced by moxifloxacin in one regimen. All drugs are administered seven days per week, and under direct observation at least five days per week. The primary outcome is tuberculosis disease-free survival at twelve months after study treatment assignment. A total of 2500 participants will be randomized; this gives 90% power to show non-inferiority with a 6.6% margin of non-inferiority. DISCUSSION This phase 3 trial formally tests the hypothesis that augmentation of rifamycin exposures can shorten tuberculosis treatment to four months. Trial design and standardized implementation optimize the likelihood of obtaining valid results. Results of this trial may have important implications for clinical management of tuberculosis at both individual and programmatic levels. TRIAL REGISTRATION NCT02410772. Registered 8 April 2015,https://www.clinicaltrials.gov/ct2/show/NCT02410772?term=02410772&rank=1.
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Affiliation(s)
- Susan E Dorman
- Medical University of South Carolina, Charleston, SC, USA.
| | - Payam Nahid
- University of California, San Francisco, California, USA
| | | | | | - Lorna Bozeman
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Kwok-Chiu Chang
- Tuberculosis and Chest Service, Department of Health, Hong Kong
| | - Michael Chen
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark Cotton
- Stellenbosch University, Cape Town, South Africa
| | - Kelly E Dooley
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Melissa Engle
- Audie L. Murphy Veterans Affairs Medical Center / University of Texas Health Science Center, San Antonio, TX, USA
| | - Pei-Jean Feng
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Phan Ha
- Vietnam National TB Program (NTP)/UCSF Research Collaboration, Hanoi, Viet Nam
| | | | - John L Johnson
- Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda
| | | | | | - Jose M Miro
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Nguyen Viet Nhung
- Vietnam National TB Program (NTP)/UCSF Research Collaboration, Hanoi, Viet Nam
| | - April C Pettit
- Vanderbilt University Medical Center, Department of Medicine, Division of Infectious Diseases, Nashville, TN, USA
| | | | | | - Anne E Purfield
- US Centers for Disease Control and Prevention, Atlanta, GA, USA; U.S. Public Health Service Commissioned Corps, Rockville, MD, USA
| | | | | | - Nigel A Scott
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Erin Sizemore
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrew Vernon
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marc Weiner
- Audie L. Murphy Veterans Affairs Medical Center / University of Texas Health Science Center, San Antonio, TX, USA
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Wang H, Song Y, Xu Z, Jing Y, He W, Feng Z, Li Q, Yang S. Abnormal Dexamethasone Suppression Tests in a Rifapentine-Treated Patient With Primary Aldosteronism. Front Endocrinol (Lausanne) 2020; 11:593. [PMID: 33013693 PMCID: PMC7499122 DOI: 10.3389/fendo.2020.00593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
Abstract
Aldosterone-producing adenoma (APA) is a main cause of primary aldosteronism (PA). Given that a large benign-appearing unilateral masse (>1 cm in diameter) may represent an aldosterone and cortisol-co-secreting adenoma, dexamethasone suppression testing is required in such patients to exclude or confirm the diagnosis of hypercortisolism. Tuberculosis is highly prevalent in China, and rifamycins are often used in these patients. Rifapentine belongs to the rifamycin family, and we herein for the first time report a case of misdiagnosis of hypercortisolism due to rifapentine use in a patient with APA. Thus, in patients treated with rifapentine, diagnosis of hypercortisolism based on dexamethasone suppression tests can be very misleading.
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Affiliation(s)
- Hongman Wang
- Department of Endocrinology, Chongqing General Hospital, Chongqing, China
| | - Ying Song
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhixin Xu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Jing
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenwen He
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengping Feng
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qifu Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shumin Yang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Shumin Yang
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Yu YY, Tsao SM, Yang WT, Huang WC, Lin CH, Chen WW, Yang SF, Chiou HL, Huang YW. Association of Drug Metabolic Enzyme Genetic Polymorphisms and Adverse Drug Reactions in Patients Receiving Rifapentine and Isoniazid Therapy for Latent Tuberculosis. Int J Environ Res Public Health 2019; 17:ijerph17010210. [PMID: 31892222 PMCID: PMC6981901 DOI: 10.3390/ijerph17010210] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/24/2019] [Accepted: 12/25/2019] [Indexed: 12/11/2022]
Abstract
Weekly rifapentine and isoniazid therapy (3HP) is the most frequent treatment for latent tuberculosis infection (LTBI). However, the association between major adverse drug reactions (ADRs) and drug metabolic enzyme single-nucleotide polymorphisms (SNPs) remains unclear. In this study, 377 participants who received the 3HP regimen were recruited and examined for genotyping of CYP5A6, CYP2B6, CYP2C19, CYP2E1, and NAT2 SNPs. In our study, 184 participants (48.4%) developed ADRs. Moreover, CYP2C19 rs4986893 (TT vs. CC+CT, odds ratio [OR] [95% CI]: 2.231 [1.015-4.906]), CYP2E1 rs2070676 (CC vs. CG+GG, OR [95% CI]: 1.563 [1.022-2.389]), and CYP2E1 rs2515641 (CC vs. CT+TT, OR [95% CI]: 1.903 [1.250-2.898]) were associated with ADR development. In conclusion, CYP2C19 and CYP2E1 SNPs may provide useful information regarding ADRs in LTBI patients receiving the 3HP regimen.
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Affiliation(s)
- Ya-Yen Yu
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (Y.-Y.Y.); (S.-F.Y.)
- Department of Clinical Laboratory, Changhua Hospital, Changhua 513, Taiwan
| | - Shih-Ming Tsao
- Division of Chest, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan;
- Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung 402, Taiwan
| | - Wen-Ta Yang
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung 403, Taiwan;
| | - Wei-Chang Huang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan;
- Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
- Department of Life Sciences, National Chung Hsing University, Taichung 402, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung 407, Taiwan
| | - Ching-Hsiung Lin
- Division of Chest, Changhua Christian Hospital, Changhua 500, Taiwan;
| | - Wei-Wen Chen
- Department of Health, Pulmonary and Critical Care Unit, Changhua Hospital, Changhua 500, Taiwan;
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (Y.-Y.Y.); (S.-F.Y.)
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Hui-Ling Chiou
- School of Medical Laboratory and Biotechnology, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Clinical Laboratory, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Correspondence: (H.-L.C.); (Y.-W.H.)
| | - Yi-Wen Huang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (Y.-Y.Y.); (S.-F.Y.)
- Department of Health, Pulmonary and Critical Care Unit, Changhua Hospital, Changhua 500, Taiwan;
- Correspondence: (H.-L.C.); (Y.-W.H.)
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Brooks KM, George JM, Pau AK, Rupert A, Mehaffy C, De P, Dobos KM, Kellogg A, McLaughlin M, McManus M, Alfaro RM, Hadigan C, Kovacs JA, Kumar P. Cytokine-Mediated Systemic Adverse Drug Reactions in a Drug-Drug Interaction Study of Dolutegravir With Once-Weekly Isoniazid and Rifapentine. Clin Infect Dis 2019; 67:193-201. [PMID: 29415190 DOI: 10.1093/cid/ciy082] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/01/2018] [Indexed: 12/18/2022] Open
Abstract
Background Once-weekly isoniazid and rifapentine for 3 months is a treatment option in persons with human immunodeficiency virus and latent tuberculosis infection. This study aimed to examine pharmacokinetic drug-drug interactions between this regimen and dolutegravir, a first-line antiretroviral medication. Methods This was a single-center, open-label, fixed-sequence, drug-drug interaction study in healthy volunteers. Subjects received oral dolutegravir 50 mg once daily alone (days 1-4) and concomitantly with once-weekly isoniazid 900 mg, rifapentine 900 mg, and pyridoxine 50 mg (days 5-19). Dolutegravir concentrations were measured on days 4, 14, and 19, and rifapentine, 25-desacetyl-rifapentine, and isoniazid concentrations were measured on day 19. Cytokines and antidrug antibodies to isoniazid and rifapentine were examined at select time points. Results The study was terminated following the development of flu-like syndrome and elevated aminotransferase levels in 2 of 4 subjects after the third isoniazid-rifapentine dose. Markedly elevated levels of interferon-γ, CXCL10, C-reactive protein, and other cytokines were temporally associated with symptoms. Antidrug antibodies were infrequently detected. Dolutegravir area under the curve (AUC) was decreased by 46% (90% confidence interval, 27-110%; P = .13) on day 14. Rifapentine and 25-desacetyl rifapentine levels on day 19 were comparable to reference data, whereas isoniazid AUCs were approximately 67%-92% higher in the subjects who developed toxicities. Conclusions The combined use of dolutegravir with once-weekly isoniazid-rifapentine resulted in unexpected and serious toxicities that were mediated by endogenous cytokine release. Additional investigations are necessary to examine the safety and efficacy of coadministering these medications. Clinical Trials Registration NCT02771249.
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Affiliation(s)
- Kristina M Brooks
- Clinical Pharmacokinetics Research Unit, Pharmacy Department, Clinical Center, National Institutes of Health (NIH), Frederick, Maryland
| | - Jomy M George
- Clinical Pharmacokinetics Research Unit, Pharmacy Department, Clinical Center, National Institutes of Health (NIH), Frederick, Maryland
| | - Alice K Pau
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases (NIAID), Bethesda, Frederick, Maryland
| | - Adam Rupert
- AIDS Monitoring Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc, Frederick, Maryland
| | - Carolina Mehaffy
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins
| | - Prithwiraj De
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins
| | - Karen M Dobos
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins
| | - Anela Kellogg
- Clinical Monitoring Research Program, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc, Frederick, Bethesda, Maryland
| | | | - Maryellen McManus
- Critical Care Medicine Department, Clinical Center, NIH, Bethesda, Maryland
| | - Raul M Alfaro
- Clinical Pharmacokinetics Research Unit, Pharmacy Department, Clinical Center, National Institutes of Health (NIH), Frederick, Maryland
| | | | - Joseph A Kovacs
- Critical Care Medicine Department, Clinical Center, NIH, Bethesda, Maryland
| | - Parag Kumar
- Clinical Pharmacokinetics Research Unit, Pharmacy Department, Clinical Center, National Institutes of Health (NIH), Frederick, Maryland
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Saini V, Ammerman NC, Chang YS, Tasneen R, Chaisson RE, Jain S, Nuermberger E, Grosset JH. Treatment-Shortening Effect of a Novel Regimen Combining Clofazimine and High-Dose Rifapentine in Pathologically Distinct Mouse Models of Tuberculosis. Antimicrob Agents Chemother 2019; 63:e00388-19. [PMID: 30936097 PMCID: PMC6535519 DOI: 10.1128/aac.00388-19] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/22/2019] [Indexed: 01/09/2023] Open
Abstract
Clofazimine and high-dose rifapentine have each separately been associated with treatment-shortening activity when incorporated into tuberculosis (TB) treatment regimens. We hypothesized that both modifications, i.e., the addition of clofazimine and the replacement of rifampin with high-dose rifapentine, in the first-line regimen for drug-susceptible TB would significantly shorten the duration of treatment necessary for cure. We tested this hypothesis in a well-established BALB/c mouse model of TB chemotherapy and also in a C3HeB/FeJ mouse model in which mice can develop caseous necrotic lesions, an environment where rifapentine and clofazimine may individually be less effective. In both mouse models, replacing rifampin with high-dose rifapentine and adding clofazimine in the first-line regimen resulted in greater bactericidal and sterilizing activity than either modification alone, suggesting that a rifapentine- and clofazimine-containing regimen may have the potential to significantly shorten the treatment duration for drug-susceptible TB. These data provide preclinical evidence supporting the evaluation of regimens combining high-dose rifapentine and clofazimine in clinical trials.
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Affiliation(s)
- Vikram Saini
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicole C Ammerman
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yong Seok Chang
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rokeya Tasneen
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Richard E Chaisson
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sanjay Jain
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eric Nuermberger
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jacques H Grosset
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Goodell AJ, Shete PB, Vreman R, McCabe D, Porco TC, Barry PM, Flood J, Marks SM, Hill A, Cattamanchi A, Kahn JG. Outlook for tuberculosis elimination in California: An individual-based stochastic model. PLoS One 2019; 14:e0214532. [PMID: 30964878 PMCID: PMC6456190 DOI: 10.1371/journal.pone.0214532] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/14/2019] [Indexed: 11/18/2022] Open
Abstract
Rationale As part of the End TB Strategy, the World Health Organization calls for low-tuberculosis (TB) incidence settings to achieve pre-elimination (<10 cases per million) and elimination (<1 case per million) by 2035 and 2050, respectively. These targets require testing and treatment for latent tuberculosis infection (LTBI). Objectives To estimate the ability and costs of testing and treatment for LTBI to reach pre-elimination and elimination targets in California. Methods We created an individual-based epidemic model of TB, calibrated to historical cases. We evaluated the effects of increased testing (QuantiFERON-TB Gold) and treatment (three months of isoniazid and rifapentine). We analyzed four test and treat targeting strategies: (1) individuals with medical risk factors (MRF), (2) non-USB, (3) both non-USB and MRF, and (4) all Californians. For each strategy, we estimated the effects of increasing test and treat by a factor of 2, 4, or 10 from the base case. We estimated the number of TB cases occurring and prevented, and net and incremental costs from 2017 to 2065 in 2015 U.S. dollars. Efficacy, costs, adverse events, and treatment dropout were estimated from published data. We estimated the cost per case averted and per quality-adjusted life year (QALY) gained. Measurements and main results In the base case, 106,000 TB cases are predicted to 2065. Pre-elimination was achieved by 2065 in three scenarios: a 10-fold increase in the non-USB and persons with MRF (by 2052), and 4- or 10-fold increase in all Californians (by 2058 and 2035, respectively). TB elimination was not achieved by any intervention scenario. The most aggressive strategy, 10-fold in all Californians, achieved a case rate of 8 (95% UI 4–16) per million by 2050. Of scenarios that reached pre-elimination, the incremental net cost was $20 billion (non-USB and MRF) to $48 billion. These had an incremental cost per QALY of $657,000 to $3.1 million. A more efficient but somewhat less effective single-lifetime test strategy reached as low as $80,000 per QALY. Conclusions Substantial gains can be made in TB control in coming years by scaling-up current testing and treatment in non-USB and those with medical risks.
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Affiliation(s)
- Alex J. Goodell
- Stanford University School of Medicine, Palo Alto, CA, United States of America
- Consortium to Assess Prevention Economics (CAPE), University of California San Francisco, San Francisco, CA, United States of America
- * E-mail:
| | - Priya B. Shete
- Consortium to Assess Prevention Economics (CAPE), University of California San Francisco, San Francisco, CA, United States of America
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, United States of America
- Curry International Tuberculosis Center, University of California, San Francisco, San Francisco, CA, United States of America
| | - Rick Vreman
- Consortium to Assess Prevention Economics (CAPE), University of California San Francisco, San Francisco, CA, United States of America
| | - Devon McCabe
- Stanford University School of Medicine, Palo Alto, CA, United States of America
- Consortium to Assess Prevention Economics (CAPE), University of California San Francisco, San Francisco, CA, United States of America
| | - Travis C. Porco
- Consortium to Assess Prevention Economics (CAPE), University of California San Francisco, San Francisco, CA, United States of America
- Proctor Foundation, University of California San Francisco, San Francisco, CA, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States of America
| | - Pennan M. Barry
- Tuberculosis Control Branch, California Department of Public Health, Richmond, CA, United States of America
| | - Jennifer Flood
- Tuberculosis Control Branch, California Department of Public Health, Richmond, CA, United States of America
| | - Suzanne M. Marks
- Division of Tuberculosis Elimination, National Center for HIV, Hepatitis, STI, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Andrew Hill
- Division of Tuberculosis Elimination, National Center for HIV, Hepatitis, STI, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Adithya Cattamanchi
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, United States of America
- Curry International Tuberculosis Center, University of California, San Francisco, San Francisco, CA, United States of America
| | - James G. Kahn
- Consortium to Assess Prevention Economics (CAPE), University of California San Francisco, San Francisco, CA, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States of America
- Philip R Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States of America
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Affiliation(s)
- Matthew J Saunders
- From the Division of Infectious Diseases and Immunity, Imperial College London, and Wellcome Trust Imperial College Centre for Global Health Research, London; and Innovation for Health and Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, and Innovación por la Salud y Desarrollo, Asociación Benéfica PRISMA, Lima, Perú
| | - Carlton A Evans
- From the Division of Infectious Diseases and Immunity, Imperial College London, and Wellcome Trust Imperial College Centre for Global Health Research, London; and Innovation for Health and Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, and Innovación por la Salud y Desarrollo, Asociación Benéfica PRISMA, Lima, Perú
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Swindells S, Ramchandani R, Gupta A, Benson CA, Leon-Cruz J, Mwelase N, Jean Juste MA, Lama JR, Valencia J, Omoz-Oarhe A, Supparatpinyo K, Masheto G, Mohapi L, da Silva Escada RO, Mawlana S, Banda P, Severe P, Hakim J, Kanyama C, Langat D, Moran L, Andersen J, Fletcher CV, Nuermberger E, Chaisson RE. One Month of Rifapentine plus Isoniazid to Prevent HIV-Related Tuberculosis. N Engl J Med 2019; 380:1001-1011. [PMID: 30865794 PMCID: PMC6563914 DOI: 10.1056/nejmoa1806808] [Citation(s) in RCA: 184] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Tuberculosis is the leading killer of patients with human immunodeficiency virus (HIV) infection. Preventive therapy is effective, but current regimens are limited by poor implementation and low completion rates. METHODS We conducted a randomized, open-label, phase 3 noninferiority trial comparing the efficacy and safety of a 1-month regimen of daily rifapentine plus isoniazid (1-month group) with 9 months of isoniazid alone (9-month group) in HIV-infected patients who were living in areas of high tuberculosis prevalence or who had evidence of latent tuberculosis infection. The primary end point was the first diagnosis of tuberculosis or death from tuberculosis or an unknown cause. Noninferiority would be shown if the upper limit of the 95% confidence interval for the between-group difference in the number of events per 100 person-years was less than 1.25. RESULTS A total of 3000 patients were enrolled and followed for a median of 3.3 years. Of these patients, 54% were women; the median CD4+ count was 470 cells per cubic millimeter, and half the patients were receiving antiretroviral therapy. The primary end point was reported in 32 of 1488 patients (2%) in the 1-month group and in 33 of 1498 (2%) in the 9-month group, for an incidence rate of 0.65 per 100 person-years and 0.67 per 100 person-years, respectively (rate difference in the 1-month group, -0.02 per 100 person-years; upper limit of the 95% confidence interval, 0.30). Serious adverse events occurred in 6% of the patients in the 1-month group and in 7% of those in the 9-month group (P = 0.07). The percentage of treatment completion was significantly higher in the 1-month group than in the 9-month group (97% vs. 90%, P<0.001). CONCLUSIONS A 1-month regimen of rifapentine plus isoniazid was noninferior to 9 months of isoniazid alone for preventing tuberculosis in HIV-infected patients. The percentage of patients who completed treatment was significantly higher in the 1-month group. (Funded by the National Institute of Allergy and Infectious Diseases; BRIEF TB/A5279 ClinicalTrials.gov number, NCT01404312.).
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Affiliation(s)
- Susan Swindells
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - Ritesh Ramchandani
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - Amita Gupta
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - Constance A Benson
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - Jorge Leon-Cruz
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - Noluthando Mwelase
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - Marc A Jean Juste
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - Javier R Lama
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - Javier Valencia
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - Ayotunde Omoz-Oarhe
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - Khuanchai Supparatpinyo
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - Gaerolwe Masheto
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - Lerato Mohapi
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - Rodrigo O da Silva Escada
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - Sajeeda Mawlana
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - Peter Banda
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - Patrice Severe
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - James Hakim
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - Cecilia Kanyama
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - Deborah Langat
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - Laura Moran
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - Janet Andersen
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - Courtney V Fletcher
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - Eric Nuermberger
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
| | - Richard E Chaisson
- From the University of Nebraska Medical Center, Omaha (S.S., C.V.F.); Harvard T.H. Chan School of Public Health, Boston (R.R., J.L.-C., J.A.); Johns Hopkins University School of Medicine, Baltimore (A.G., E.N., R.E.C.), and Social and Scientific Systems, Silver Spring (L. Moran) - both in Maryland; University of California, San Diego, School of Medicine, La Jolla (C.A.B.); GHESKIO, Port-au-Prince, Haiti (M.A.J.J., P.S.); Asociación Civil Impacta Salud y Educación, Lima, Peru (J.R.L., J.V.); Botswana-Harvard AIDS Partnership, Gaborone, Botswana (A.O.-O., G.M.); Chiang Mai University, Chiang Mai, Thailand (K.S.); Helen Joseph Hospital, Johannesburg (N.M.), Perinatal HIV Research Unit, Soweto (L. Mohapi), and the University of Kwa-Zulu Natal, Durban (S.M.) - all in South Africa; Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro (R.O.S.E.); Johns Hopkins-Blantyre Clinical Trials Unit, Blantyre (P.B.), and the University of North Carolina-Lilongwe Clinical Research Site, Lilongwe (C.K.) - both in Malawi; the University of Zimbabwe, Harare (J.H.); and Kenya Medical Research Institute-Walter Reed Clinical Research Site, Nairobi (D.L.)
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Shastay A. Name Mix-Up: RifAMPin and Rifapentine. Home Healthc Now 2019; 37:295-296. [PMID: 31483364 DOI: 10.1097/nhh.0000000000000819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Ann Shastay
- Ann Shastay, MSN, RN, AOCN, is the Managing Editor, Institute for Safe Medication Practices, Horsham, Pennsylvania
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Njie GJ, Morris SB, Woodruff RY, Moro RN, Vernon AA, Borisov AS. Isoniazid-Rifapentine for Latent Tuberculosis Infection: A Systematic Review and Meta-analysis. Am J Prev Med 2018; 55:244-252. [PMID: 29910114 PMCID: PMC6097523 DOI: 10.1016/j.amepre.2018.04.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/22/2018] [Accepted: 04/23/2018] [Indexed: 01/22/2023]
Abstract
CONTEXT Latent tuberculosis infection diagnosis and treatment is a strategic priority for eliminating tuberculosis in the U.S. The Centers for Disease Control and Prevention has recommended the short-course regimen of 3-month isoniazid-rifapentine administered by directly observed therapy. However, longer-duration regimens remain the most widely prescribed latent tuberculosis infection treatments. Limitation on adoption of 3-month isoniazid-rifapentine in the U.S. might be because of patients' preference for self-administered therapy, providers' lack of familiarity with 3-month isoniazid-rifapentine, or lack of resources to support directly observed therapy. This review examines the most recent evidence regarding 3-month isoniazid-rifapentine's effectiveness, safety, and treatment completion when directly compared with other latent tuberculosis infection regimens primarily comprising 9-month isoniazid treatment. EVIDENCE ACQUISITION Using Community Guide methodology, reviewers identified, evaluated, and summarized available evidence published during January 2006-June 2017. Analysis of the data was completed in 2017. EVIDENCE SYNTHESIS The analysis included 15 unique studies. Three-month isoniazid-rifapentine was determined to be equal to other latent tuberculosis infection regimens in effectiveness (OR=0.89, 95% CI=0.46, 1.70), and has higher treatment completion (87.5%, 95% CI=83.2%, 91.3%) compared with other latent tuberculosis infection regimens (65.9%, 95% CI=53.5%, 77.3%). Three-month isoniazid-rifapentine was associated with similar risk to other latent tuberculosis infection regimens for adverse events (relative risk=0.59, 95% CI=0.23, 1.52); discontinuing treatment because of adverse events (relative risk=0.48, 95% CI=0.17, 1.34); and death (relative risk=0.79, 95% CI=0.56, 1.11). CONCLUSIONS The 3-month isoniazid-rifapentine regimen is as safe and effective as other recommended latent tuberculosis infection regimens and achieves significantly higher treatment completion rates.
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Affiliation(s)
- Gibril J Njie
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Sapna Bamrah Morris
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rachel Yelk Woodruff
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ruth N Moro
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; CDC Foundation Research Collaboration, Atlanta, Georgia
| | - Andrew A Vernon
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrey S Borisov
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Vanbrabant TJF, Dijkmans AC, den Hartigh J, Touw DJ, Arend SM. Rifampin levels in daily practice: the accuracy of a single measurement. Neth J Med 2018; 76:235-242. [PMID: 30019679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Measurement of rifampin levels is not part of routine practice. However, low levels are associated with failure of tuberculosis treatment. The clinical relevance of serum levels in daily practice is unclear. The objective was to evaluate rifampin serum concentrations and factors associated with insufficient concentrations. METHODS Patients with at least one rifampin concentration drawn 3 hours after intake (C3) between 2005 and 2014 were included. Data on demographic and clinical characteristics were collected, including side effects and dose adjustments. Two different criteria were used to define adequate concentrations (criterion 1: C3 a nd C 6 ≥ 3 mg/l; criterion 2: C3 or C6 ≥ 5 mg/l). RESULTS Of 63 patients, 66% and 76% had a sufficient level according to criterion 1 or 2, respectively. C3 exceeded C6 in most patients, while a late maximum was significantly associated with diabetes mellitus (p = 0.003). A dose adjustment was made in 19% of cases, more frequently in patients with insufficient levels (p = 0.02) or with ≥ 2 side effects (p = 0.03). CONCLUSION Rifampin levels varied but were mostly adequate and a single measurement at 3 hours after intake provided the required information in most cases, indicating that full AUC0-24 measurements could be limited to specific situations.
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Affiliation(s)
- T J F Vanbrabant
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
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Specht S, Pfarr KM, Arriens S, Hübner MP, Klarmann-Schulz U, Koschel M, Sternberg S, Martin C, Ford L, Taylor MJ, Hoerauf A. Combinations of registered drugs reduce treatment times required to deplete Wolbachia in the Litomosoides sigmodontis mouse model. PLoS Negl Trop Dis 2018; 12:e0006116. [PMID: 29300732 PMCID: PMC5771630 DOI: 10.1371/journal.pntd.0006116] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 01/17/2018] [Accepted: 11/15/2017] [Indexed: 01/22/2023] Open
Abstract
Filarial parasites can be targeted by antibiotic treatment due to their unique endosymbiotic relationship with Wolbachia bacteria. This finding has led to successful treatment strategies in both, human onchocerciasis and lymphatic filariasis. A 4–6 week treatment course using doxycycline results in long-term sterility and safe macrofilaricidal activity in humans. However, current treatment times and doxycycline contraindications in children and pregnant women preclude widespread administration of doxycycline in public health control programs; therefore, the search for shorter anti-wolbachial regimens is a focus of ongoing research. We have established an in vivo model for compound screening, using mice infected with Litomosoides sigmodontis. We could show that gold standard doxycycline treatment did not only deplete Wolbachia, it also resulted in a larval arrest. In this model, combinations of registered antibiotics were tested for their anti-wolbachial activity. Administration of rifamycins in combination with doxycycline for 7 days successfully depleted Wolbachia by > 2 log (>99% reduction) and thus resulted in a significant reduction of the treatment duration. Using a triple combination of a tetracycline (doxycycline or minocycline), a rifamycin and a fluoroquinolone (moxifloxacin) led to an even greater shortening of the treatment time. Testing all double combinations that could be derived from the triple combinations revealed that the combination of rifapentine (15mg/kg) and moxifloxacin (2 x 200mg/kg) showed the strongest reduction of treatment time in intraperitoneal and also oral administration routes. The rifapentine plus moxifloxacin combination was equivalent to the triple combination with additional doxycycline (>99% Wolbachia reduction). These investigations suggest that it is possible to shorten anti-wolbachial treatment times with combination treatments in order to achieve the target product profile (TPP) requirements for macrofilaricidal drugs of no more than 7–10 days of treatment. Over the past years, more attention has been brought to neglected tropical diseases including lymphatic filariasis and onchocerciasis. The latter are caused by helminthic parasites and lead to chronic and debilitating symptoms and present a major health burden that also affects the economy of endemic countries. It has been suggested that disease elimination may be possible but an accelerated implementation of proven and cost-effective interventions are needed if the targets for elimination are to be achieved. Recently, an indirect mode of action has been identified, targeting bacterial Wolbachia endosymbionts within the filariae, which also kills the adult parasites, an advantage over the drug currently used for mass drug administration, i.e. ivermectin. Doxycycline has been successfully used in clinical trials, however due to its long regimen as well as restrictions of use in children and pregnant women new drugs or drug combinations are required that overcome these obstacles. Here, we present the filarial parasite Litomosoides sigmodontis as suitable model for the preclinical testing of anti-wolbachial drugs against filariae and show that combinations of already registered drugs with anti-wolbachial efficacy are able to reduce the treatment time dramatically.
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Affiliation(s)
- Sabine Specht
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
- Institute for Laboratory Animal Science, Vetsuisse Faculty, University of Zurich, Switzerland
- * E-mail:
| | - Kenneth M. Pfarr
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany
| | - Sandra Arriens
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Marc P. Hübner
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Ute Klarmann-Schulz
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany
| | - Marianne Koschel
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Sonja Sternberg
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Coralie Martin
- UMR 7245 MCAM MNHN CNRS, Museum National d`Histoire Naturelle, Paris, France
| | - Louise Ford
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Mark J. Taylor
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany
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Stock D. National position statement for the management of latent tuberculosis infection. Commun Dis Intell (2018) 2017; 41:E204-E208. [PMID: 29720068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
UNLABELLED The primary role of any tuberculosis (TB) control program is to ensure the prompt identification and effective treatment of active disease. The host immune system often succeeds in containing the initial (or primary) infection with Mycobacterium tuberculosis (Mtb), but may fail to eliminate the pathogen. The persistence of viable organisms explains the potential for the development of active disease years or even decades after infection. This is known as latent tuberculosis infection (LTBI) although, rather than a distinct entity, this probably represents part of a dynamic spectrum. Individuals with LTBI are asymptomatic and it is therefore clinically undetectable. The World Health Organization (WHO) estimates that one-third of the global population has been infected with Mtb, with highest prevalence of LTBI in countries/regions with the highest prevalence of active disease. In 2013, 88% of 1322 notifications in Australia were in the overseas-born population (incidence 19.5 per 100,000 v. 1.0 per 100,000), with this proportion rising over the course of the last decade. Combined with epidemiological evidence of low local transmission, this strongly implies that the vast majority resulted from reactivation of latent infection acquired prior to immigration. Contrasting trends in TB incidence in other developed countries probably reflect differences in policy regarding LTBI. CONCLUSION The diagnosis and treatment of LTBI represents an important opportunity for intervention by jurisdictional TB control programs.
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Affiliation(s)
- David Stock
- Staff Specialist Respiratory and General Medicine Royal Hobart Hospital
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Holzschuh EL, Province S, Johnson K, Walls C, Shemwell C, Martin G, Showalter A, Dunlay J, Conyers A, Griffin P, Tausz N. Use of Video Directly Observed Therapy for Treatment of Latent Tuberculosis Infection - Johnson County, Kansas, 2015. MMWR Morb Mortal Wkly Rep 2017; 66:387-389. [PMID: 28406884 PMCID: PMC5657805 DOI: 10.15585/mmwr.mm6614a3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Pease C, Hutton B, Yazdi F, Wolfe D, Hamel C, Quach P, Skidmore B, Moher D, Alvarez GG. Efficacy and completion rates of rifapentine and isoniazid (3HP) compared to other treatment regimens for latent tuberculosis infection: a systematic review with network meta-analyses. BMC Infect Dis 2017; 17:265. [PMID: 28399802 PMCID: PMC5387294 DOI: 10.1186/s12879-017-2377-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 04/01/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We conducted a systematic review and network meta-analysis (NMA) to examine the efficacy and completion rates of treatments for latent tuberculosis infection (LTBI). While a previous review found newer, short-duration regimens to be effective, several included studies did not confirm LTBI, and analyses did not account for variable follow-up or assess completion. METHODS We searched MEDLINE, Embase, CENTRAL, PubMed, and additional sources to identify RCTs in patients with confirmed LTBI that involved a regimen of interest and reported on efficacy or completion. Regimens of interest included isoniazid (INH) with rifapentine once weekly for 12 weeks (INH/RPT-3), 6 and 9 months of daily INH (INH-6; INH-9), 3-4 months daily INH plus rifampicin (INH/RFMP 3-4), and 4 months daily rifampicin alone (RFMP-4). NMAs were performed to compare regimens for both endpoints. RESULTS Sixteen RCTs (n = 44,149) and 14 RCTs (n = 44,128) were included in analyses of efficacy and completion. Studies were published between 1968 and 2015, and there was diversity in patient age and comorbidities. All regimens of interest except INH-9 showed significant benefits in preventing active TB compared to placebo. Comparisons between active regimens did not reveal significant differences. While definitions of regimen completion varied across studies, regimens of 3-4 months were associated with a greater likelihood of adequate completion. CONCLUSIONS Most of the active regimens showed an ability to reduce the risk of active TB relative to no treatment, however important differences between active regimens were not found. Shorter rifamycin-based regimens may offer comparable benefits to longer INH regimens. Regimens of 3-4 months duration are more likely to be completed than longer regimens.
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Affiliation(s)
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6 Canada
- Ottawa University School of Epidemiology, Public Health and Preventive Medicine, Ottawa, Canada
| | - Fatemeh Yazdi
- Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6 Canada
| | - Dianna Wolfe
- Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6 Canada
| | - Candyce Hamel
- Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6 Canada
| | - Pauline Quach
- Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6 Canada
| | - Becky Skidmore
- Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6 Canada
| | - David Moher
- Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6 Canada
- Ottawa University School of Epidemiology, Public Health and Preventive Medicine, Ottawa, Canada
| | - Gonzalo G. Alvarez
- Department of Medicine, The Ottawa Hospital, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6 Canada
- Ottawa University Faculty of Medicine, Ottawa, Canada
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McClintock AH, Eastment M, McKinney CM, Pitney CL, Narita M, Park DR, Dhanireddy S, Molnar A. Treatment completion for latent tuberculosis infection: a retrospective cohort study comparing 9 months of isoniazid, 4 months of rifampin and 3 months of isoniazid and rifapentine. BMC Infect Dis 2017; 17:146. [PMID: 28196479 PMCID: PMC5310079 DOI: 10.1186/s12879-017-2245-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 02/07/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The U.S. Centers for Disease Control and Prevention (CDC) recommended a new regimen for treatment of latent tuberculosis (three months of weekly isoniazid and rifapentine) in late 2011. While completion rates of this regimen were reported to be higher than nine months of isoniazid, little is known about the completion rates of three months of isoniazid and rifapentine compared to nine months of isoniazid or four months of rifampin in actual use scenarios. METHODS We conducted a retrospective cohort study comparing treatment completion for latent tuberculosis (TB) infection in patients treated with nine months of isoniazid, three months of isoniazid and rifapentine or four months of rifampin in outpatient clinics and a public health TB clinic in Seattle, Washington. The primary outcome of treatment completion was defined as 270 doses of isoniazid within 12 months, 120 doses of rifampin within six months and 12 doses of isoniazid and rifapentine within four months. RESULTS Three hundred ninety-three patients were included in the study. Patients were equally likely to complete three months of weekly isoniazid and rifapentine or four months of rifampin (85% completion rate of both regimens), as compared to 52% in the nine months of isoniazid group (p < 0.001). These associations remained statistically significant even after adjusting for clinic location and type of monitoring. Monitoring type (weekly versus monthly versus less often than monthly) had less impact on treatment completion than the type of treatment offered. CONCLUSIONS Patients were equally as likely to complete the three months of isoniazid and rifapentine as four months of rifampin. Four months of rifampin is similar in efficacy compared to placebo as isoniazid and rifapentine but does not require directly observed therapy (DOT), and is less expensive compared to combination therapy with isoniazid and rifapentine, and thus can be the optimal treatment regimen to achieve the maximal efficacy in a community setting.
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Affiliation(s)
- Adelaide H. McClintock
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Box 354765, 4245 Roosevelt Way NE, Seattle, WA 98105 USA
| | - McKenna Eastment
- Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, USA
| | - Christy M. McKinney
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Box 354765, 4245 Roosevelt Way NE, Seattle, WA 98105 USA
| | | | - Masahiro Narita
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, USA
- Tuberculosis Control Program, Public Health - Seattle & King County, Seattle, USA
| | - David R. Park
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, USA
| | - Shireesha Dhanireddy
- Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, USA
| | - Alexandra Molnar
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Box 354765, 4245 Roosevelt Way NE, Seattle, WA 98105 USA
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Chauffour A, Robert J, Veziris N, Aubry A, Jarlier V. Sterilizing Activity of Fully Oral Intermittent Regimens against Mycobacterium Ulcerans Infection in Mice. PLoS Negl Trop Dis 2016; 10:e0005066. [PMID: 27755552 PMCID: PMC5068736 DOI: 10.1371/journal.pntd.0005066] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 09/21/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The treatment of Buruli ulcer (BU) that is caused by Mycobacterium ulcerans, is currently based on a daily administration of rifampin and streptomycin (RIF-STR). A fully oral intermittent regimen would greatly simplify its treatment on the field. METHODOLOGY/PRINCIPAL FINDINGS The objective of this study was to assess the bactericidal and sterilizing activities of intermittent oral regimens in a murine model of established M. ulcerans infection. Regimens combining rifapentine (RFP 20 mg/kg) with either moxifloxacin (MXF 200 mg/kg), clarithromycin (CLR 100 mg/kg) or bedaquiline (BDQ 25 mg/kg) were administrated twice (2/7) or three (only for RFP-CLR 3/7) times weekly during 8 weeks. The bactericidal but also the sterilizing activities of these four intermittent oral regimens were at least as good as those obtained with control weekdays regimens, i.e. RFP-CLR 5/7 or RIF-STR 5/7. A single mouse from the RFP-MFX 2/7 group had culture-positive relapse at the end of the 28 weeks following treatment completion among the 157 mice treated with one of the four intermittent regimens (40 RFP-CLR 2/7, 39 RFP-CLR 3/7, 39 RFP-MXF 2/7, 39 RFP-BDQ 2/7). CONCLUSIONS/SIGNIFICANCE These results open the door for a fully intermittent oral drug regimen for BU treatment avoiding intramuscular injections and facilitating supervision by health care workers.
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Affiliation(s)
- Aurélie Chauffour
- Sorbonne Universités, UPMC Univ Paris 06, CR7, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, CIMI, Team E13 (Bactériologie), F-75013, Paris, France
- * E-mail:
| | - Jérôme Robert
- Sorbonne Universités, UPMC Univ Paris 06, CR7, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, CIMI, Team E13 (Bactériologie), F-75013, Paris, France
- APHP, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Bactériologie-Hygiène, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, F-75013, Paris, France
| | - Nicolas Veziris
- Sorbonne Universités, UPMC Univ Paris 06, CR7, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, CIMI, Team E13 (Bactériologie), F-75013, Paris, France
- APHP, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Bactériologie-Hygiène, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, F-75013, Paris, France
| | - Alexandra Aubry
- Sorbonne Universités, UPMC Univ Paris 06, CR7, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, CIMI, Team E13 (Bactériologie), F-75013, Paris, France
- APHP, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Bactériologie-Hygiène, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, F-75013, Paris, France
| | - Vincent Jarlier
- Sorbonne Universités, UPMC Univ Paris 06, CR7, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, CIMI, Team E13 (Bactériologie), F-75013, Paris, France
- APHP, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Bactériologie-Hygiène, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, F-75013, Paris, France
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42
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Srinivas NR. Interspecies scaling of excretory amounts using allometry - retrospective analysis with rifapentine, aztreonam, carumonam, pefloxacin, miloxacin, trovafloxacin, doripenem, imipenem, cefozopran, ceftazidime, linezolid for urinary excretion and rifapentine, cabotegravir, and dolutegravir for fecal excretion. Xenobiotica 2016; 46:784-92. [PMID: 26711252 DOI: 10.3109/00498254.2015.1121554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 11/11/2015] [Accepted: 11/15/2015] [Indexed: 11/13/2022]
Abstract
1. Interspecies allometry scaling for prediction of human excretory amounts in urine or feces was performed for numerous antibacterials. Antibacterials used for urinary scaling were: rifapentine, pefloxacin, trovafloxacin (Gr1/low; <10%); miloxacin, linezolid, PNU-142300 (Gr2/medium; 10-40%); aztreonam, carumonam, cefozopran, doripenem, imipenem, and ceftazidime (Gr3/high; >50%). Rifapentine, cabotegravir, and dolutegravir was used for fecal scaling (high; >50%). 2. The employment of allometry equation: Y = aW(b) enabled scaling of urine/fecal amounts from animal species. Corresponding predicted amounts were converted into % recovery by considering the respective human dose. Comparison of predicted/observed values enabled fold difference and error calculations (mean absolute error [MAE] and root mean square error [RMSE]). Comparisons were made for urinary/fecal data; and qualitative assessment was made amongst Gr1/Gr2/Gr3 for urine. 3. Average correlation coefficient for the allometry scaling was >0.995. Excretory amount predictions were largely within 0.75- to 1.5-fold differences. Average MAE and RMSE were within ±22% and 23%, respectively. Although robust predictions were achieved for higher urinary/fecal excretion (>50%), interspecies scaling was applicable for low/medium excretory drugs. 4. Based on the data, interspecies scaling of urine or fecal excretory amounts may be potentially used as a tool to understand the significance of either urinary or fecal routes of elimination in humans in early development.
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Affiliation(s)
- Nuggehally R Srinivas
- a Department of Integrated Drug Development , Suramus Bio , Bangalore , Karnataka , India
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43
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Abstract
Treatment of latent tuberculosis infection (LTBI) is essential for eradicating tuberculosis (TB). Moreover, the patient adherence is crucial in determining the effectiveness of TB control. Isoniazid given by DOTS daily for 9 months (9H) is the standard treatment for LTBI in Taiwan. However, the completion rate is low due to the long treatment period and its side effects. The combined regimen using a high dose of rifapentine/isoniazid once weekly for 12 weeks (3HP) has been used as an alternative treatment option for LTBI in the United States. This may result in a higher completion rate. In this pilot study, patient adherence and cost of these 2 treatment regimens were investigated. Thus, we aimed to assess the treatment completion rate and costs of 3HP and compare to those with 9H.Data from 691 cases of LTBI treatments including 590 cases using the conventional regimen and 101 cases with rifapentine/Isoniazid were collected. The cost was the sum of the cost of treatment with Isoniazid for 9 months or with rifapentin/Isoniazid for 3 months of all contacts. The effectiveness was the cost of cases of tuberculosis avoided.In this study, the treatment completion rate for patients prescribed with the 3 months rifapentine/isoniazid regimen (97.03%) was higher than those given the conventional 9-month isoniazid regimen (87.29%) (P <0.001). The cost of 3HP and 9H was US$261.24 and US$717.3, respectively. The cost-effectiveness ratio with isoniazid for 9 months was US$ 15392/avoided 1 case of tuberculosis and US$ 5225/avoided 1 case of tuberculosis with 3HP. In addition, when compared with the conventional regimen, there were fewer patients discontinued with rifapentine/isoniazid regimen due to undesirable side effects.This was the first study to compare the 2 treatment regimens in Taiwan, and it showed that a short-term high-dosage rifapentine/isoniazid treatment regimen reduced costs and resulted in higher treatment completion than the standard LTBI isoniazid treatment.
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Affiliation(s)
- Yi-Wen Huang
- Institute of Medicine, Chung Shan Medical University, Taichung
- Pulmonary and Critical Care Unit, Changhua Hospital, Department of Health, Changhua
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung
| | | | - Thomas Chang-Yao Tsao
- Institute of Medicine, Chung Shan Medical University, Taichung
- Division of Chest, Department of Internal Medicine, Chung Shan Medical University Hospital
| | - Shih-Ming Tsao
- Division of Chest, Department of Internal Medicine, Chung Shan Medical University Hospital
- Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan
- Correspondence: Shih-Ming Tsao, 110 Chien-Kuo N. Road, Section 1, Taichung 40201, Taiwan (e-mail: )
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Parumasivam T, Chan JGY, Pang A, Quan DH, Triccas JA, Britton WJ, Chan HK. In vitro evaluation of novel inhalable dry powders consisting of thioridazine and rifapentine for rapid tuberculosis treatment. Eur J Pharm Biopharm 2016; 107:205-14. [PMID: 27422209 DOI: 10.1016/j.ejpb.2016.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/06/2016] [Accepted: 07/11/2016] [Indexed: 02/03/2023]
Abstract
Thioridazine is an orally administered antipsychotic drug with potential for treatment of drug-resistant tuberculosis (TB). However, drug-induced adverse cardiac effects have been reported when thioridazine was used at an efficacious oral dose of 200mg/day to treat TB. Pulmonary delivery of thioridazine could be a rational approach to reduce dose-related side effects while enabling high drug concentrations at the primary site of infection. The present study compares in vitro aerosol performance, storage stability, and in vitro antimicrobial activity and cytotoxicity of two inhalable powders composed of thioridazine and a first-line anti-TB drug, rifapentine. Formulation 1 is a combination of amorphous thioridazine and crystalline rifapentine, while Formulation 2 consisted of both drugs as amorphous forms. Both thioridazine-rifapentine formulations were found suitable for inhalation with a total fine particle fraction (<5μm) of 68-76%. The two powders had similar MIC90 to rifapentine alone, being 0.000625μg/mL and 0.005μg/ml against Mycobacterium tuberculosis H37Ra and M. tuberculosis H37Rv, respectively. In contrast, thioridazine alone had a MIC90 of 12.5μg/mL and 500μg/mL, against M. tuberculosis H37Ra and M. tuberculosis H37Rv, respectively, demonstrating no synergistic anti-TB activity. However, thioridazine and rifapentine in a ratio of 1:3 enhanced the killing of M. tuberculosis H37Ra within the human monocyte-derived macrophages (THP-1) compared to the single drug treatments. Both powders showed an acceptable half maximal inhibitory concentration (IC50) of 31.25μg/mL on both THP-1 and human lung epithelial (A549) cells. However, Formulation 1 showed greater chemical stability than Formulation 2 after three months of storage under low humidity (vacuum) at 20±3°C. In conclusion, we have demonstrated a novel inhalable powder consisted of amorphous thioridazine and crystalline rifapentine (Formulation 1) with a good aerosol performance, potent anti-TB activity and storage stability, which deserves further in vivo investigations.
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Affiliation(s)
- T Parumasivam
- Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney, 2006 NSW, Australia
| | - J G Y Chan
- Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney, 2006 NSW, Australia; JHL Biotech, Inc., Hsinchu County, Taiwan
| | - A Pang
- Tuberculosis Research Program, Centenary Institute, and The University of Sydney, Sydney 2042, NSW, Australia
| | - D H Quan
- Infectious Diseases and Immunology, Sydney Medical School, The University of Sydney, 2006 NSW, Australia
| | - J A Triccas
- Infectious Diseases and Immunology, Sydney Medical School, The University of Sydney, 2006 NSW, Australia
| | - W J Britton
- Infectious Diseases and Immunology, Sydney Medical School, The University of Sydney, 2006 NSW, Australia; Tuberculosis Research Program, Centenary Institute, and The University of Sydney, Sydney 2042, NSW, Australia
| | - H K Chan
- Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney, 2006 NSW, Australia.
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Joseph P, Ponnaiya J, Das M, Chaitanya VS, Arumugam S, Ebenezer M. Evaluation of anti-bacterial activity of Rifapentine, Clarithromycin, Minocycline, Moxifloxacin, Ofloxacin and their combinations in Murine Model of Rifampicin Resistant Leprosy. Indian J Lepr 2016; 88:147-158. [PMID: 30207440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Leprosy, a debilitating disease of the skin and peripheral nerves is caused by Mycobacterium leprae (M. leprae) and is treated by multidrug therapy (MDT) comprising of Dapsone, Rifampicin and Clofazimine. Resistance to any of these drugs poses a threat to the current disease control strategies. With the emergence of Rifampicin resistance in leprosy, it is important that alternative drugs need to be tested to develop a treatment strategy to combat drug resistant leprosy. In the current study, we have investigated WHO MDT, Rifapentine, Clarithromycin, Minocycline, Moxifloxacin, Ofloxacin and their combinations in intermittent and daily dose regimens in rifampicin resistant strains of M. leprae through mouse foot pad experiments in order to determine the loss in viability of M. leprae in response to these drugs and their combinations. Our findings suggest that WHO MDT is still the best combination in Rifampicin resistance cases. Combination of Moxifloxacin with Minocycline and Clarithromycin may also be taken up for clinical trials in cases with Rifampicin resistant leprosy. Rifapentine and Moxifloxacin can be effective alternative drugs to replace Rifampicin where required either in daily dose shorter duration regimens or intermittent dose longer regimen to treat resistant strains.
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46
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Conde MB, Mello FCQ, Duarte RS, Cavalcante SC, Rolla V, Dalcolmo M, Loredo C, Durovni B, Armstrong DT, Efron A, Barnes GL, Marzinke MA, Savic RM, Dooley KE, Cohn S, Moulton LH, Chaisson RE, Dorman SE. A Phase 2 Randomized Trial of a Rifapentine plus Moxifloxacin-Based Regimen for Treatment of Pulmonary Tuberculosis. PLoS One 2016; 11:e0154778. [PMID: 27159505 PMCID: PMC4861335 DOI: 10.1371/journal.pone.0154778] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 04/19/2016] [Indexed: 11/19/2022] Open
Abstract
Background The combination of rifapentine and moxifloxacin administered daily with other anti-tuberculosis drugs is highly active in mouse models of tuberculosis chemotherapy. The objective of this phase 2 clinical trial was to determine the bactericidal activity, safety, and tolerability of a regimen comprised of rifapentine, moxifloxacin, isoniazid, and pyrazinamide administered daily during the first 8 weeks of pulmonary tuberculosis treatment. Methods Adults with sputum smear-positive pulmonary tuberculosis were randomized to receive either rifapentine (approximately 7.5 mg/kg) plus moxifloxacin (investigational arm), or rifampin (approximately 10 mg/kg) plus ethambutol (control) daily for 8 weeks, along with isoniazid and pyrazinamide. The primary endpoint was sputum culture status at completion of 8 weeks of treatment. Results 121 participants (56% of accrual target) were enrolled. At completion of 8 weeks of treatment, negative cultures using Löwenstein-Jensen (LJ) medium occurred in 47/60 (78%) participants in the investigational arm vs. 43/51 (84%, p = 0.47) in the control arm; negative cultures using liquid medium occurred in 37/47 (79%) in the investigational arm vs. 27/41 (66%, p = 0.23) in the control arm. Time to stable culture conversion was shorter for the investigational arm vs. the control arm using liquid culture medium (p = 0.03), but there was no difference using LJ medium. Median rifapentine area under the concentration-time curve (AUC0-24) was 313 mcg*h/mL, similar to recent studies of rifapentine dosed at 450–600 mg daily. Median moxifloxacin AUC0-24 was 28.0 mcg*h/mL, much lower than in trials where rifapentine was given only intermittently with moxifloxacin. The proportion of participants discontinuing assigned treatment for reasons other than microbiological ineligibility was higher in the investigational arm vs. the control arm (11/62 [18%] vs. 3/59 [5%], p = 0.04) although the proportions of grade 3 or higher adverse events were similar (5/62 [8%] in the investigational arm vs. 6/59 [10%, p = 0.76] in the control arm). Conclusion For intensive phase daily tuberculosis treatment in combination with isoniazid and pyrazinamide, a regimen containing moxifloxacin plus low dose rifapentine was at least as bactericidal as the control regimen containing ethambutol plus standard dose rifampin. Trial Registration www.ClinicalTrials.govNCT00728507
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Affiliation(s)
- Marcus B. Conde
- Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda C. Q. Mello
- Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael Silva Duarte
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Solange C. Cavalcante
- Municipal Health Secretariat, Rio de Janeiro, Brazil
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Valeria Rolla
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Margareth Dalcolmo
- Centro de Referência Hélio Fraga, Ministério da Saúde, Fiocruz Rio de Janeiro, Brazil
| | - Carla Loredo
- Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Derek T. Armstrong
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Anne Efron
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Grace L. Barnes
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Mark A. Marzinke
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Radojka M. Savic
- University of California San Francisco, San Francisco, California, United States of America
| | - Kelly E. Dooley
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Silvia Cohn
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Lawrence H. Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Richard E. Chaisson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Susan E. Dorman
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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Goutal S, Auvity S, Legrand T, Hauquier F, Cisternino S, Chapy H, Saba W, Tournier N. Validation of a simple HPLC-UV method for rifampicin determination in plasma: Application to the study of rifampicin arteriovenous concentration gradient. J Pharm Biomed Anal 2016; 123:173-8. [PMID: 26907700 DOI: 10.1016/j.jpba.2016.02.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 02/10/2016] [Accepted: 02/11/2016] [Indexed: 11/18/2022]
Abstract
In clinical practice, rifampicin exposure is estimated from its concentration in venous blood samples. In this study, we hypothesized that differences in rifampicin concentration may exist between arterial and venous plasma. An HPLC-UV method for determining rifampicin concentration in plasma using rifapentine as an internal standard was validated. The method, which requires a simple protein precipitation procedure as sample preparation, was performed to compare venous and arterial plasma kinetics after a single therapeutic dose of rifampicin (8.6 mg/kg i.v, infused over 30 min) in baboons (n=3). The method was linear from 0.1 to 40 μg mL(-1) and all validation parameters fulfilled the international requirements. In baboons, rifampicin concentration in arterial plasma was higher than in venous plasma. Arterial Cmax was 2.1±0.2 fold higher than venous Cmax. The area under the curve (AUC) from 0 to 120 min was ∼80% higher in arterial plasma, indicating a significant arteriovenous concentration gradient in early rifampicin pharmacokinetics. Arterial and venous plasma concentrations obtained 6h after rifampicin injection were not different. An important arteriovenous equilibration delay for rifampicin pharmacokinetics is reported. Determination in venous plasma concentrations may considerably underestimate rifampicin exposure to organs during the distribution phase.
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Affiliation(s)
- Sébastien Goutal
- IMIV, CEA, Inserm, CNRS, Univ. Paris-Sud, Université Paris Saclay, CEA-SHFJ, Orsay, France.
| | - Sylvain Auvity
- IMIV, CEA, Inserm, CNRS, Univ. Paris-Sud, Université Paris Saclay, CEA-SHFJ, Orsay, France; Variabilité de réponse aux psychotropes, INSERM, U1144, 75006 Paris, France; Université Paris Descartes, UMR-S 1144, Paris F-75006, France
| | - Tiphaine Legrand
- Laboratoire de Pharmacologie-Toxicologie, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, 94000 Créteil, France
| | - Fanny Hauquier
- LICSEN, NIMBE, CEA, CNRS, Université Paris-Saclay, CEA Saclay 91191 Gif-sur-Yvette Cedex, France
| | - Salvatore Cisternino
- Variabilité de réponse aux psychotropes, INSERM, U1144, 75006 Paris, France; Université Paris Descartes, UMR-S 1144, Paris F-75006, France
| | - Hélène Chapy
- Variabilité de réponse aux psychotropes, INSERM, U1144, 75006 Paris, France; Université Paris Descartes, UMR-S 1144, Paris F-75006, France
| | - Wadad Saba
- IMIV, CEA, Inserm, CNRS, Univ. Paris-Sud, Université Paris Saclay, CEA-SHFJ, Orsay, France
| | - Nicolas Tournier
- IMIV, CEA, Inserm, CNRS, Univ. Paris-Sud, Université Paris Saclay, CEA-SHFJ, Orsay, France
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Getahun H, Matteelli A, Abubakar I, Aziz MA, Baddeley A, Barreira D, Den Boon S, Borroto Gutierrez SM, Bruchfeld J, Burhan E, Cavalcante S, Cedillos R, Chaisson R, Chee CBE, Chesire L, Corbett E, Dara M, Denholm J, de Vries G, Falzon D, Ford N, Gale-Rowe M, Gilpin C, Girardi E, Go UY, Govindasamy D, D Grant A, Grzemska M, Harris R, Horsburgh CR, Ismayilov A, Jaramillo E, Kik S, Kranzer K, Lienhardt C, LoBue P, Lönnroth K, Marks G, Menzies D, Migliori GB, Mosca D, Mukadi YD, Mwinga A, Nelson L, Nishikiori N, Oordt-Speets A, Rangaka MX, Reis A, Rotz L, Sandgren A, Sañé Schepisi M, Schünemann HJ, Sharma SK, Sotgiu G, Stagg HR, Sterling TR, Tayeb T, Uplekar M, van der Werf MJ, Vandevelde W, van Kessel F, van't Hoog A, Varma JK, Vezhnina N, Voniatis C, Vonk Noordegraaf-Schouten M, Weil D, Weyer K, Wilkinson RJ, Yoshiyama T, Zellweger JP, Raviglione M. Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries. Eur Respir J 2015; 46:1563-76. [PMID: 26405286 PMCID: PMC4664608 DOI: 10.1183/13993003.01245-2015] [Citation(s) in RCA: 373] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 08/26/2015] [Indexed: 12/21/2022]
Abstract
Latent tuberculosis infection (LTBI) is characterised by the presence of immune responses to previously acquired Mycobacterium tuberculosis infection without clinical evidence of active tuberculosis (TB). Here we report evidence-based guidelines from the World Health Organization for a public health approach to the management of LTBI in high risk individuals in countries with high or middle upper income and TB incidence of <100 per 100 000 per year. The guidelines strongly recommend systematic testing and treatment of LTBI in people living with HIV, adult and child contacts of pulmonary TB cases, patients initiating anti-tumour necrosis factor treatment, patients receiving dialysis, patients preparing for organ or haematological transplantation, and patients with silicosis. In prisoners, healthcare workers, immigrants from high TB burden countries, homeless persons and illicit drug users, systematic testing and treatment of LTBI is conditionally recommended, according to TB epidemiology and resource availability. Either commercial interferon-gamma release assays or Mantoux tuberculin skin testing could be used to test for LTBI. Chest radiography should be performed before LTBI treatment to rule out active TB disease. Recommended treatment regimens for LTBI include: 6 or 9 month isoniazid; 12 week rifapentine plus isoniazid; 3-4 month isoniazid plus rifampicin; or 3-4 month rifampicin alone.
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Affiliation(s)
| | - Alberto Matteelli
- The Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Ibrahim Abubakar
- Dept of Infection and Population Health, University College London, London, UK Public Health England, London, UK
| | - Mohamed Abdel Aziz
- World Health Organization, Regional Office for Eastern Mediterranean, Egypt
| | - Annabel Baddeley
- The Global TB Programme, World Health Organization, Geneva, Switzerland
| | | | | | | | - Judith Bruchfeld
- Unit of Infectious Diseases, Dept of Medicine, Karolinska Institute Solna and Karolinska University Hospital, Stockholm, Sweden
| | - Erlina Burhan
- Dept of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Indonesia and Persahabatan Hospital, Jakarta, Indonesia
| | - Solange Cavalcante
- Evandro Chagas National Institute of Infectious Diseases, FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Richard Chaisson
- Center for TB Research, John Hopkins University, Baltimore, MD, USA
| | | | | | | | - Masoud Dara
- World Health Organization, Regional Office for Europe, Denmark
| | | | | | - Dennis Falzon
- The Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Nathan Ford
- Dept of HIV and Global Hepatitis Programme, World Health Organization, Switzerland
| | | | - Chris Gilpin
- The Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Enrico Girardi
- Istituto Nazionale Malattie Infettive L. Spallanzani, Rome, Italy
| | - Un-Yeong Go
- Dept of HIV/AIDS and TB Control Korea, Korea Centers for Disease Control and Prevention, Republic of Korea
| | - Darshini Govindasamy
- Health Systems Research Unit, South African Medical Research Council, South Africa
| | - Alison D Grant
- Dept of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - C Robert Horsburgh
- Dept of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | | | - Ernesto Jaramillo
- The Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Sandra Kik
- McGill International TB Centre, and Dept of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
| | - Katharina Kranzer
- Dept of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Knut Lönnroth
- The Global TB Programme, World Health Organization, Geneva, Switzerland Dept of Public Health Sciences, Karolinska Institute, Solna, Sweden
| | - Guy Marks
- Woolcock Institute of Medical Research University of Sydney and UNSW Australia, Sydney, Australia
| | - Dick Menzies
- McGill International TB Centre, and Dept of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
| | | | - Davide Mosca
- Migration Health Department, International Organization of Migration, Geneva, Switzerland
| | - Ya Diul Mukadi
- Infectious Disease Division, Bureau for Global Health, US Agency for International Development, Washington, DC, USA
| | | | - Lisa Nelson
- Dept of HIV and Global Hepatitis Programme, World Health Organization, Switzerland
| | - Nobuyuki Nishikiori
- World Health Organization, Regional Office for the Western Pacific, Philippines
| | | | - Molebogeng Xheedha Rangaka
- Dept of Infection and Population Health, University College London, London, UK Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Andreas Reis
- Knowledge, Ethics and Research Department, World Health Organization, Switzerland
| | - Lisa Rotz
- Centers for Disease Control and Prevention, USA
| | - Andreas Sandgren
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Holger J Schünemann
- Dept of Clinical Epidemiology and Biostatistics and Dept of Medicine, GRADE Center, McMaster University, Hamilton, ON, Canada
| | | | - Giovanni Sotgiu
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Helen R Stagg
- Dept of Infection and Population Health, University College London, London, UK
| | | | - Tamara Tayeb
- National TB Programme, Ministry of Health, Riyadh, Saudi Arabia
| | - Mukund Uplekar
- The Global TB Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Femke van Kessel
- Pallas Health Research and Consultancy BV, Rotterdam, The Netherlands
| | - Anna van't Hoog
- Academic Medical Centre, University of Amsterdam, Dept of Global Health, Amsterdam, The Netherlands
| | - Jay K Varma
- Centers for Disease Control and Prevention, USA
| | | | | | | | - Diana Weil
- The Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Karin Weyer
- The Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Robert John Wilkinson
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa Francis Crick Institute Mill Hill Laboratory, Dept of Medicine, Imperial College London, London, UK
| | - Takashi Yoshiyama
- Fukujuji Hospital, Japan Anti Tuberculosis Association, Tokyo, Japan
| | | | - Mario Raviglione
- The Global TB Programme, World Health Organization, Geneva, Switzerland
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Sterling TR, Moro RN, Borisov AS, Phillips E, Shepherd G, Adkinson NF, Weis S, Ho C, Villarino ME. Flu-like and Other Systemic Drug Reactions Among Persons Receiving Weekly Rifapentine Plus Isoniazid or Daily Isoniazid for Treatment of Latent Tuberculosis Infection in the PREVENT Tuberculosis Study. Clin Infect Dis 2015; 61:527-35. [PMID: 25904367 PMCID: PMC4560029 DOI: 10.1093/cid/civ323] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 04/12/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Weekly rifapentine plus isoniazid for 3 months (3HP) is as effective as daily isoniazid for 9 months (9H) for latent tuberculosis infection in high-risk persons, but there have been reports of possible flu-like syndrome. METHODS We identified clinically significant systemic drug reactions (SDR) and evaluated risk factors in patients who did not complete treatment in the PREVENT Tuberculosis study. RESULTS Among 7552 persons who received ≥ 1 dose of study drug, 153 had a SDR: 138/3893 (3.5%) with 3HP vs 15/3659 (0.4%) with 9H (P < .001). In the 3HP arm, 87 (63%) had flu-like syndrome and 23 (17%) had cutaneous reactions; 13/3893 (0.3%) had severe reactions (6 were hypotensive) and 6 reported syncope. Symptoms occurred after a median of 3 doses, and 4 hours after the dose; median time to resolution was 24 hours. There were no deaths. In multivariate logistic regression analysis, factors independently associated with SDR included receipt of 3HP (adjusted odds ratio [aOR] 9.4; 95% confidence interval [CI], 5.5, 16.2), white non-Hispanic race/ethnicity (aOR 3.3; 95% CI, 2.3, 4.7), female sex (aOR 2.0; 95% CI, 1.4, 2.9), age ≥ 35 years (aOR 2.0; 95% CI, 1.4, 2.9), and lower body mass index (body mass index [BMI]; P = .009). In a separate multivariate analysis among persons who received 3HP, severe SDR were associated with white non-Hispanic race/ethnicity (aOR 5.4; 95% CI, 1.8, 16.3), and receipt of concomitant non-study medications (aOR 5.9; 95% CI, 1.3, 27.1). CONCLUSIONS SDR were more common with 3HP, and mostly flu-like. Persons of white race, female sex, older age, and lower BMI were at increased risk. Severe reactions were rare and associated with 3HP, concomitant medication, and white race. The underlying mechanism is unclear. CLINICAL TRIALS REGISTRATION NCT00023452.
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Affiliation(s)
| | - Ruth N. Moro
- Centers for Disease Control and Prevention
- CDC Foundation, Research Collaboration, Atlanta, Georgia
| | | | - Elizabeth Phillips
- Vanderbilt University School of Medicine, Nashville, Tennessee
- Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Australia
| | - Gillian Shepherd
- New York-Presbyterian Hospital/Weill Cornell Medical Center, New York
| | | | - Stephen Weis
- University of North Texas Health Science Center at Ft. Worth
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