Isoniazid versus alternative regimens for the treatment of latent tuberculosis in children: A systematic review and network meta-analysis

Background: Treatment of Latent Tuberculosis Infection (LTBI) is a therapeutic dilemma. The current systematic review has been conducted to differentiate the efficacy and safety of isoniazid (INH) versus alternative regimens for preventing active tuberculosis in children. Methods: A detailed analysis of the randomized controlled trials, methodology, interventions, and outcomes was done. Electronic searching was done through different databases. The dichotomous data (binary data) were reported as Odds ratios (ORs). Initially, a direct meta-analysis was performed that differentiated various interventions. The network meta-analysis was performed and ranking was done according to Surface under the cumulative ranking curve (SUCRA). Results: The systematic review included data from 4 randomized controlled trials, comprising 2978 participants for analyzing efficacy, treatment completion rate, and adverse effects. The most efficacious intervention for the treatment of LTBI included INH + Rifampin (RIF) ([OR], 0.44; 95% confidence interval [CI], 0.29-0.65). INH + RIF Rifampicin (OR, 0.30; 95% CI, 0.17-0.54) intervention reported a lesser number of adverse events in the experimental group compared to control group. All alternative regimens were superior in treatment completion rate compared to INH monotherapy. Ranking probability based on SUCRA reported that RIF + pyrazinamide (PZA) (SUCRA 61.3) had the probability of most efficacious intervention, RIF + PZA (SUCRA 46.8) in treatment completion rate and INH + Rifapentine (SUCRA 83.9) had the least adverse effects in LTBI. Conclusions: INH + RIF was found to be the most effective intervention for the LTBI treatment in respect of treatment efficacy and with tolerable adverse events. All alternative regimens were also effective.