{"id":2205,"date":"2011-12-08T17:37:27","date_gmt":"2011-12-08T22:37:27","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=2205"},"modified":"2015-06-04T15:15:23","modified_gmt":"2015-06-04T19:15:23","slug":"big-tb-prevention-study-important-and-highly-relevant-even-here","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/big-tb-prevention-study-important-and-highly-relevant-even-here\/2011\/12\/08\/","title":{"rendered":"Big TB Prevention Study Important, Highly Relevant — Even Here"},"content":{"rendered":"

As I’ve noted before<\/a>, tuberculosis is disappearing from the United States — which means that the bulk of cutting-edge research in TB (both clinical and basic science) has little relevance to US-based practitioners.<\/p>\n

But over in NEJM<\/em>, a much-anticipated TB study is published today<\/a> that is highly <\/em>relevant:<\/p>\n

We conducted an open-label, randomized noninferiority trial comparing 3 months of directly observed once-weekly therapy with rifapentine (900 mg) plus isoniazid (900 mg) (combination-therapy group) with 9 months of self-administered daily isoniazid (300 mg) (isoniazid-only group) in subjects at high risk for tuberculosis. Subjects were enrolled from the United States, Canada, Brazil, and Spain <\/strong> … Tuberculosis developed in 7 of 3986 subjects in the combination-therapy group (cumulative rate, 0.19%) and in 15 of 3745 subjects in the isoniazid-only group (cumulative rate, 0.43%), for a difference of 0.24 percentage points.<\/p><\/blockquote>\n

Just how relevant is this study?<\/p>\n

\"\"<\/a>At the risk of over sharing, I would have been eligible to participate:\u00a0Back in medical school, I cared for an elderly man with cough, weight loss, and lung cancer — only he didn’t have lung cancer, he had TB (oops). My next TB skin test was positive\u00a0when I started internship, and I was advised to take 9 months of preventive therapy with INH.<\/p>\n

Only I didn’t — not initially. For whatever reason, I \u00a0somehow deluded myself into thinking it was a false-positive (just a little redness … right) and continued blithely on this path through both residency and ID fellowship.<\/p>\n

Not smart, I know. Selfish, foolish youth.<\/p>\n

Only when I became an actual ID specialist did it finally click. Needing another skin test before starting my job, I could no longer ignore the 15 mm welt on my arm. Nor could I bear the thought of harming my patients, never mind the painful irony and public health nightmare that would ensue if an ID specialist got active TB — headline: “ID Doc Infects Dozens; Ignored Advice He Gave Others.”<\/p>\n

I finally took the INH. Oh, and it was no big deal.<\/p>\n

But if I had the choice back then of 12 doses, taken once a week? Somehow this seems just so much easier, and I suspect I would have accepted treatment sooner had this option been available.<\/p>\n

And as this short-course regimen enters formal treatment guidelines<\/a>, I have a hunch it will be widely adopted\u00a0— without<\/em> the recommended directly observed component.<\/p>\n

Do you agree?<\/p>\n","protected":false},"excerpt":{"rendered":"

As I’ve noted before, tuberculosis is disappearing from the United States — which means that the bulk of cutting-edge research in TB (both clinical and basic science) has little relevance to US-based practitioners. But over in NEJM, a much-anticipated TB study is published today that is highly relevant: We conducted an open-label, randomized noninferiority trial […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,5,6,8,10],"tags":[531,649,812,898,951],"class_list":["post-2205","post","type-post","status-publish","format-standard","hentry","category-health-care","category-infectious-diseases","category-medical-education","category-patient-care","category-research","tag-isoniazid","tag-new-england","tag-rifapentine","tag-tb","tag-tuberculosis"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/2205","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=2205"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/2205\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=2205"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=2205"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=2205"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}