Efficacy and Safety Rifapentine-Containing Regimen for Drug Sensitive Tuberculosis: Systematic Review and Meta-Analysis

1 resistant TB with approximately 410000 cases of multidrug resistant/rifampicin-resistant TB globally 3 .Therefore, tuberculosis treatment needs to be carried out in a shorter and easier manner than the current six-month daily regimen, thereby increasing adherence and potentially reducing adverse drug effects 1,4,5 .Rifapentine, a cyclopentyl ring-substituted rifamycin with a longer half-life than rifampicin, is active against M. tuberculosis.Therefore, the potential of rifapentine for enhanced treatment has been explored.The US Food and Drug Administration approved rifapentine for the treatment of active tuberculosis, at a dose of 1200 mg weekly in combination with other antituberculosis drugs 6,7 .Preclinical research on mouse models has demonstrated that three months of daily rifapentine therapy is sufficient to cure patients.In tuberculosis treatment, the rifapentinebased regimen for 4 months containing moxifloxacin was not inferior to the standard regimen for 6 months 8,9 .The combination of rifapentine and moxifloxacin was active in ABSTRACT INTRODUCTION Newer regimens are needed and expected to have a shorter therapeutic time to increase drug adherence to completion in drug sensitive tuberculosis (DS-TB) patients.METHODS We conducted first a systematic review and meta-analysis of prior studies to evaluate the effectiveness of rifapentine-containing regimens in treating DS-TB patients.Various search engines and keywords based on the PICOS framework for article selection were applied.Using Cochrane's risk-ofbias (RoB 2), data were independently extracted and the quality of the data was evaluated.Efficacy and safety data were evaluated by risk ratio and odds ratio, respectively.RESULTS Five eligible studies met the inclusion criteria.The rifapentinecontaining regimen had improved significantly the rate of sputum conversion (OR=0.04;95% CI: 0.03-0.07).The rifapentine-containing regimen did not have a significant difference in both efficacy (RR=1.02;95% CI: 0.96-1.09)and adverse events (RR=0.96;95% CI: 0.78-1.18) to the standard regimen.Rifapentine-containing regimen with optimal dosage of 1200 mg had an overall non-significant sputum conversion rate difference to previous regimens.CONCLUSIONS To our knowledge, this is the first systematic review and meta-analysis that studied the efficacy and safety of a rifapentine-containing regimen for DS-TB.The shorter duration (4 months) of the rifapentinecontaining regimen, suggested by WHO, may give superior benefit of adherence and lower resistance compared to past therapeutic suggestions.The novel once per day rifapentine-containing regimen is effective and safe, with significantly shorter treatment durations and is not inferior compared to standard regimens (RHZE) for the treatment of DS-TB.