Defining the optimal dose of rifapentine for pulmonary tuberculosis: Exposure–response relations from two phase II clinical trials

for the Tuberculosis Trials Consortium of the Centers for Disease Control and Prevention

Research output: Contribution to journalArticle

30 Scopus citations

Abstract

Rifapentine is a highly active antituberculosis antibiotic with treatment-shortening potential; however, exposure–response relations and the dose needed for maximal bactericidal activity have not been established. We used pharmacokinetic/pharmacodynamic data from 657 adults with pulmonary tuberculosis participating in treatment trials to compare rifapentine (n = 405) with rifampin (n = 252) as part of intensive-phase therapy. Population pharmacokinetic/pharmacodynamic analyses were performed with nonlinear mixed-effects modeling. Time to stable culture conversion of sputum to negative was determined in cultures obtained over 4 months of therapy. Rifapentine exposures were lower in participants who were coinfected with human immunodeficiency virus, black, male, or fasting when taking drug. Rifapentine exposure, large lung cavity size, and geographic region were independently associated with time to culture conversion in liquid media. Maximal treatment efficacy is likely achieved with rifapentine at 1,200 mg daily. Patients with large lung cavities appear less responsive to treatment, even at high rifapentine doses.

Original languageEnglish (US)
Pages (from-to)321-331
Number of pages11
JournalClinical Pharmacology and Therapeutics
Volume102
Issue number2
DOIs
StatePublished - Aug 1 2017

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

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