P-1202. Comparative Effectiveness of Host-Directed Therapies for Tuberculosis: A Systematic Review and Network Meta-Analysis

Abstract Background Host-directed therapies (HDTs) are emerging as promising adjuncts to anti-tuberculosis treatment (ATT), aiming to improve early bacteriological clearance and reduce treatment failures. This network meta-analysis (NMA) evaluated the efficacy of various HDTs in achieving negative sputum conversion at 4 and 8 weeks, using standard ATT (isoniazid, rifampin, ethambutol, pyrazinamide) as the referenceGraphical AbstractGraphical abstract showing key findings.Risk of bias analysisRisk of bias Methods A systematic review identified randomized controlled trials (RCTs) comparing HDTs—Interleukin-2 (IL-2), Immunoxel, Metformin, Mycobacterium vaccae, Statins, V5 Immunitor, and Vitamin D—plus ATT versus ATT alone. A Bayesian random-effects NMA using a binomial likelihood with logit link estimated odds ratios (ORs) and 95% credible intervals (CrIs). A frequentist NMA was conducted for comparison. Outcomes were sputum conversion at 4 and 8 weeksCumulative rankogram of host directed therapies in TuberculosisRadiogram showing pictorial representation of various treatment armsGraph showing SUCRA scores of Host directed therapies in Tuberculosis managementGraph showing sucre scores of the various HDTs used in the studies analyzed. Results Twenty-eight RCTs (4,260 patients) were included. At 4 weeks, V5 Immunitor (OR 30.7; CrI 11.0–102), Immunoxel (OR 5.68; CrI 1.82–17.4), and Mycobacterium vaccae (OR 2.05; CrI 0.996–4.94) ranked highest. IL-2, Vitamin D, and Statins showed modest, non-significant effects; Metformin had lower efficacy (OR 0.716; CrI 0.137–3.69). At 8 weeks, V5 Immunitor remained top (OR 35.4; CrI 8.89–201), followed by Vitamin D and M. vaccae. Frequentist models confirmed large effects for V5 Immunitor and Immunoxel for sputum conversion to negative at 4 weeks. Heterogeneity was moderate. Conclusion V5 Immunitor and Immunoxel significantly improved early sputum conversion when added to ATT. Findings were consistent across Bayesian and frequentist models, supporting potential inclussion of HDTs in tuberculosis therapy. Disclosures All Authors: No reported disclosures