Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2026 Jan 1;212(1):129-137.
doi: 10.1164/rccm.202411-2340OC.

The effectiveness of isoniazid preventive treatment among contacts of multidrug-resistant tuberculosis: a systematic review and individual-participant meta-analysis

Leonardo Martinez  1 , Jeffrey I Campbell  2 , Lauren Linde  1 , Fadila Boulahbal  3 , Joan A Cayla  4 , Tsira Chakhaia  5 , Pei-Chun Chan  6   7   8 , Cheng Chen  9 , Chi-Tai Fang  8   10 , Greg Fox  11 , Louis Grandjean  12 , Djohar Hannoun  13 , Anneke Hesseling  14 , C Robert Horsburgh  1 , Li-Min Huang  7 , Qiao Liu  9 , Rufaida Mazahir  15 , Chih-Hsin Lee  16   17 , Li-Na Lee  18 , Rutger Bennet  19 , Sahar Nejat  19 , Amita Gupta  20 , Mrinalini Das  21 , Megan Murray  22   23   24 , Chuan-Chin Huang  22   23 , Helena Del Corral  25 , Dione Benjumea-Bedoya  25 , Ye Shen  26 , Mercedes Becerra  23 , Vicky Chang  27   28 , Sonya Krishnan  20 , Petra Heinmueller  29 , Timothy Brewer  30 , Petros Isaakidis  21   31 , Anja M Hauri  32 , Lena Shah  33 , Lisa Trieu  34 , James A Seddon  14   35
Affiliations
Free article
Review

The effectiveness of isoniazid preventive treatment among contacts of multidrug-resistant tuberculosis: a systematic review and individual-participant meta-analysis

Leonardo Martinez et al. Am J Respir Crit Care Med. .
Free article

Abstract

Rationale: Recent empirical research suggests that isoniazid may lead to a risk reduction of incident tuberculosis (TB) among close TB contacts of someone with multidrug-resistant TB (MDR-TB).

Objectives: To evaluate the association between isoniazid TB preventive treatment (TPT), compared to no treatment, upon incident TB in household contacts of MDR-TB cases using a large global consortium of TB contact tracing studies.

Methods: We conducted a systematic review and individual-participant meta-analysis among observational studies of household contact tracing studies. Participants were included if they were exposed to someone with MDR-TB and were given either 6 months of isoniazid TPT or no TPT. Our primary outcome was incident TB in contacts exposed to TB. We derived adjusted hazard ratios (aHRs) using mixed-effects, multivariable survival regression models with study-level random effects. The effectiveness of isoniazid TPT against incident TB was estimated through propensity score matching.

Measurements and main results: We included participant-level data from 6668 contacts exposed to MDR-TB from 17 countries. The effectiveness of isoniazid TPT against incident TB in contacts of MDR-TB was 57% (aHR, 0.43 [95% CI, 0.26-0.71]) and did not appreciably change with adjustment for additional potential confounders. The reduction in incident TB was marginally greater among child (<20 years old) contacts (aHR, 0.51 [95% CI, 0.28-0.92) compared to adult contacts (aHR, 0.69 [95% CI, 0.22-2.20]). The reduction in incidence was 73% (aHR, 0.27 [95% CI, 0.11-0.70]) in the first year of follow-up; effectiveness dropped to 60% (aHR, 0.40 [95% CI, 0.15-1.06]) from 12 to 23 months of follow-up and was nonsignificant after 2 years (28% effectiveness; aHR, 0.72 [95% CI, 0.33-1.54]).

Conclusions: Among >6500 contacts of MDR-TB, isoniazid TPT was highly effective in preventing incident TB. The reduction was greatest in high-burden countries and waned after 2 years of follow-up.

PubMed Disclaimer