Authors: Gao, X-F.¹; Li, J.²; Yang, Z-W.³; Li, Y-P.⁴

Source: The International Journal of Tuberculosis and Lung Disease, Volume 13, Number 7, July 2009 , pp. 810-819(10)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

OBJECTIVE: To evaluate the efficacy and safety of rifapentine (RPT) vs. rifampicin (RMP) for the treatment of pulmonary tuberculosis (PTB).

DESIGN: Systematic review of randomised controlled trials (RCTs) that compared combination drug regimens containing RPT with those containing RMP for the treatment of drug-susceptible or previously untreated PTB.

RESULTS: Nine RCTs were identified. Statistically significant differences were not found in the cure rates, severe adverse effects, severe hepatotoxicity or bacteriological relapse rates between the regimens containing once- or twice-weekly RPT and those containing daily RMP for human immunodeficiency virus (HIV) negative patients, but were found in the bacteriological relapse rates between regimens containing once-weekly or less frequent RPT and those containing twice- or thrice-weekly RMP: the pooled relative risks in the two subgroups were respectively 1.71 (95%CI 1.13-2.58, P = 0.01) and 2.44 (95%CI 1.15-5.18, P = 0.02). The trial for HIV-positive patients did not show significant differences in the sputum conversion rate, severe adverse effects or bacteriological relapse rate between the RPT- and RMP-containing regimens; four of the five relapses were associated with the RPT-containing regimen, but none of the three relapses with the RMP-containing regimen produced monoresistance to rifamycin (RIF).

CONCLUSION: Once- or twice-weekly RPT and daily RMP have similar efficacy and safety for the treatment of HIV-negative PTB, but once-weekly or less frequent use of RPT, in comparison with twice- or thrice-weekly RMP, increases the risk of bacteriological relapse. RPT might increase the risk of resistance to RIF in HIV-positive patients.

Keywords: pulmonary tuberculosis; rifapentine; rifampicin; systematic review

Document Type: Review article

Affiliations: 1: Department of Preventive Medicine, North Sichuan Medical College, Nanchong, Sichuan, China; and Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China 2: Department of Preventive Medicine, North Sichuan Medical College, Nanchong, Sichuan, China 3: Morphometric Research Laboratory, North Sichuan Medical College, Nanchong, Sichuan, China 4: Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China

Publication date: 2009-07-01

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• The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

  Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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