Rifapentine—a cyclopentyl ring–substituted rifamycin that showed greater activity against Mycobacterium leprae than rifampin in murine models of leprosy—lowered the risk of contracting leprosy among household contacts of infected patients vs no preventive intervention, according to a report published by Wang et al in The New England Journal of Medicine. In a Chinese, cluster-randomized, controlled trial, clusters (counties or districts in China) were randomly assigned to receive single-dose rifapentine (68 clusters, n = 2,331 household contacts), single-dose rifampin (71 clusters, n = 2,760), or no intervention (68 clusters, n = 2,359). After 4 years of follow-up, there was a cumulative incidence rate of leprosy of 0.09% with rifapentine (2 cases), 0.33% with rifampin (9 cases), and 0.55% with no intervention (13 cases); overall, the incidence of leprosy was 92% lower after a single dose of rifapentine than receiving no intervention. Previous trials also demonstrated the activity of rifampin in preventing leprosy among household contacts; therefore, rifapentine may represent an additional agent in the leprosy treatment armamentarium. The study authors concluded, “Our data show that rifapentine can protect household contacts from leprosy in areas in which the endemic level of the disease is low. As a feasible preventive intervention for household contacts of patients with leprosy, both single-dose rifapentine and single-dose rifampin are being considered in the national program for the eradication of leprosy in China.”
June 01, 2023