{
  "abstract": "Objectives High-dose rifamycin (HDR) regimens have demonstrated significant potential in tuberculosis (TB) treatment. This study aims to evaluate the efficacy and safety profile of different HDR regimens.Design Using a systematic review and Bayesian network meta-analysis (NMA).Data sources PubMed, Web of Science, Cochrane Library and Embase were searched up to 2 November 2024.Eligibility criteria for selecting studies Randomised controlled trials that compared the efficacy and safety of HDR regimens (rifampin 15–30 mg/kg/day and rifapentine 7.5–20 mg/kg/day) to standard-dose rifampin in patients with pulmonary drug-susceptible TB were included.Data extraction and synthesis The risk of bias was assessed using Cochrane tools. We conducted NMA with GEMTC in R. The simulation was performed using the Markov Chain Monte Carlo technique set on four parallel chains, with 20 000 burn-in iterations, 50 000 inference iterations and a thinning factor of n=2.5. To check for model convergence, Gelman and Rubin diagnostic plots and density plots were applied. We assessed heterogeneity using the I² test, evaluated transitivity by comparing effect modifiers across studies and examined consistency via node-splitting analysis. The confidence in network meta-analysis online tool and Cochrane Risk of Bias 2.0 Tool were used to assess evidence certainty and risk of bias, respectively. Higher surface area under the cumulative rank curve scores indicated a higher probability of top-ranking treatments.Results Out of 15 766 citations screened, 15 randomised controlled trials were included, encompassing 6456 subjects. The risk of bias was low in 14 studies, with some concerns in one. Patients receiving rifapentine 20 mg/kg/day (risk ratio, 1.09; 95% credible interval, 1.03 to 1.17) had higher culture conversion rates at 8 weeks in solid culture compared with the control. There was no significant difference in primary efficacy within all HDR regimens. Rifapentine 20 mg/kg/day was ranked as the most effective intervention for primary efficacy. No statistical difference in the incidence of serious adverse events was found between all regimens.Conclusions Rifapentine 20 mg/kg/day may be the most effective for achieving the strongest anti-TB activity. All HDR regimens demonstrated good safety.PROSPERO registration number CRD42024504575.",
  "authors": [
    {
      "affiliations": [
        "Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China"
      ],
      "name": "Zhen Feng"
    },
    {
      "affiliations": [
        "Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China",
        "Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai, China"
      ],
      "name": "Hailan Wu"
    },
    {
      "affiliations": [
        "Department of Tuberculosis Internal Medicine II, Hunan Province Chest Hospital, Changsha, China"
      ],
      "name": "Qian Li"
    },
    {
      "affiliations": [
        "Department of Infectious Disease, The First People's Hospital of Linping District, Hangzhou, Zhejiang, China"
      ],
      "name": "Xiaoqiang Zhang"
    },
    {
      "affiliations": [
        "Department of Clinical Pharmacy & Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China"
      ],
      "name": "Qingfeng He"
    },
    {
      "affiliations": [
        "Division of Infectious Diseases, Department of Internal Medicine, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"
      ],
      "name": "Hangxing Wang"
    },
    {
      "affiliations": [
        "Department of Infectious Disease, The First People's Hospital of Linping District, Hangzhou, Zhejiang, China"
      ],
      "name": "Jianping Yu"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China"
      ],
      "name": "Shijia Ge"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China"
      ],
      "name": "Lingyun Song"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China"
      ],
      "name": "Yilin Zhang"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China"
      ],
      "name": "Xian Zhou"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China",
        "Shanghai Sci-Tech Inno Center for Infection & Immunity, Shanghai, China"
      ],
      "name": "Feng Sun"
    },
    {
      "affiliations": [
        "Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China",
        "Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai, China"
      ],
      "name": "Jing Zhang"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China"
      ],
      "name": "Yang Li"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China",
        "Shanghai Sci-Tech Inno Center for Infection & Immunity, Shanghai, China"
      ],
      "name": "Wenhong Zhang"
    }
  ],
  "title": "Comparative efficacy and safety of high-dose rifamycin regimens for tuberculosis treatment: a Bayesian network meta-analysis",
  "uid": "fa376a6e-18f1-5182-81e2-2224efbe2c96"
}