Safety of tuberculosis preventive treatment among people receiving or about to initiate immunosuppressive medications: a systematic review and meta-analysis.

Authors

Anabel Selemon, Maria Lima Fernandes, Kamila Romanowski, Luca Melnychuk, Dick Menzies, Victoria J Cook, Dina Fisher, Rachel K Lim, Sarah K Brode, James C Johnston, Mayara L Bastos, Jonathon R Campbell

Published in

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. Sep 21, 2026. Epub Sep 21, 2026.

Abstract

People receiving immunosuppressive medications are at increased risk of tuberculosis. Tuberculosis preventive treatment (TPT) can reduce risk, however its safety among these populations is uncertain. We conducted a meta-analysis to evaluate adverse events (AE) associated with TPT among people receiving or about to initiate immunosuppressive medications.
We searched MEDLINE, Cochrane, Health Star, and EMBASE (1952-May 1, 2025), for studies reporting AE during TPT among people receiving or about to initiate immunosuppressives. We used random-effects generalized linear mixed models with Hartung-Knapp 95% confidence intervals to estimate our primary outcome: pooled proportion of AE-related discontinuation, stratified by TPT regimen.
We included 27 studies (3184 participants). Populations included biologics/steroids recipients and solid organ/hematopoietic transplant candidates/recipients. For the primary outcome (25 studies, 2802 participants), TPT regimens included 6-12-month mono-isoniazid regimens (1511 participants), 4-months mono-rifamycin regimens (228 participants), 3-month isoniazid-rifamycin combination regimens (990 participants), and 6-9-month fluoroquinolone-based regimens (73 participants). Only mono-isoniazid regimens were provided while receiving immunosuppressives. Pooled AE-related discontinuation was 5.3% (95% CI: 3.1-8.9%; I2=65.4%) for mono-isoniazid regimens, 4.4% (95% CI: 0.1-75.4%; I2=86.3%) for mono-rifamycin regimens, 2.0% (1.0-4.1%; I2=0.0%) for isoniazid-rifamycin combination regimens, and 6.9% (95% CI: 0-92.3%; I2=65.4%) for fluoroquinolone-based regimens. Proportions were similar when stratified by biologics/steroids and transplant populations.
Overall, AE-related TPT discontinuation was like the broader TPT literature. AE-related discontinuation of TPT was lowest with rifamycin-containing regimens, but these were only provided prior to initiating immunosuppressives. Data on the safety of non-isoniazid regimens among people receiving immunosuppressives are needed.

PMID:
42765630
Bibliographic data and abstract were imported from PubMed on 21 Sep 2026.

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