Preventive guide leaps hurdles, nearing print
Just a few changes in emphasis, then out the door
The new guidelines on preventive therapy for latent TB infection have passed another milestone, bringing them to the last step before publication. The guidelines should be out by the end of the year, says Rick O’Brien, MD, chief of the Research and Evaluation Branch at the Division of Tuberculosis Elimination at the Centers for Disease Control and Prevention in Atlanta.
The guidelines’ last big hurdle was approval by the American Thoracic Society (ATS). Pending two editorial revisions, that approval has been granted, says O’Brien.
First, the ATS asked that the final document give slightly more emphasis to the risk of isoniazid-associated (INH) hepatitis, he says.
The second change is more subtle. The ATS has asked that the document emphasize more strongly that even though analysis of data suggests nine months of INH is probably just as effective as 12 months, the data supporting 12 are actually "more solid data," says O’Brien. "The argument that nine months is comparable is based on sub-analyses of older clinical trials and constitutes what’s termed a post-hoc analysis. We argue, and the ATS agrees, that the really strong evidence still favors 12 months of INH."
None of this editorial tweaking means the content of the actual recommendations will change; thus, state programs will retain the option to use nine months or, if administrators agree that circumstances are sufficiently compelling enough, six months of INH.
The guidelines will hit print at roughly the same time in two publications: the Morbidity and Mortality Weekly Report and the ATS Journal of Respiratory and Critical Care Medicine.
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