Abstract
ObjectiveManagement of multidrug-resistant tuberculosis (MDR-TB) is a significant challenge to the global healthcare system due to the complexity and long duration of the MDR-TB treatment. This study analyzed the safety of patients on longer injectable-based MDR-TB treatment regimens using active pharmacovigilance data.MethodWe conducted an observational, prospective study based on active pharmacovigilance within the national TB program. A total of 659 MDR-TB patients were enrolled and followed up at 9 TB- hospitals in 9 provinces of all 3 regions in Vietnam between 2014 and 2016. Patients received a treatment regimen (standardized or individualized) based on their drug susceptibility test result and their treatment history. Baseline and follow-up information was collected at the start and during treatment. Adverse events (AE) were defined and classified as serious adverse events (SAEs) or otherwise. Multivariate Cox regression following the Iterative Bayesian Model Averaging algorithm was performed to identify factors associated with AE occurrence.ResultsOut of 659 patients assessed, 71.3% experienced at least one AE, and 17.5% suffered at least one SAE. The most common AEs were gastrointestinal disorders (38.5%), arthralgia (34.7%), and psychiatric disorders (30.0%). The proportion of patients with nephrotoxicity and hearing loss or vestibular disorders were 7.4% and 15.2%, respectively. 13.1% of patients required modifications or interruption of one or more drugs. In 77.7% of patients, treatment was completed successfully, while 9.3% lost to follow-up, in 3.0% treatment failed, and 7.4% died. Some significant risk factors for nephrotoxicity included diabetes mellitus (HR = 8.46 [1.91–37.42]), renal dysfunction (HR = 8.46 [1.91–37.42]), alcoholism (HR = 13.28 [5.04–34.99]), and a higher average daily dose of injectable drugs (HR = 1.28 [1.14–1.43]).ConclusionWhile a majority of patients on the longer injectable-based regimens experienced non-serious AEs during MDR-TB treatment, one in six patients experienced at least an SAE. Active TB drug-safety monitoring is useful to understand the safety of MDR-TB treatment and explore the risk factors for toxicity. All-oral, shorter MDR-TB regimens might be able to reduce the inconvenience, discomfort, and toxicity of such regimens and increase adherence and likelihood of successful completion.
Highlights
Multidrug-resistant tuberculosis (MDR-TB) is a significant threat to global healthcare systems and TB control
While a majority of patients on the longer injectable-based regimens experienced non-serious Adverse events (AE) during MDR-TB treatment, one in six patients experienced at least an serious adverse events (SAEs)
To have a comprehensive picture of adverse events (AEs) that MDR-TB patients sustained during the whole period of treatment, cohort event monitoring (CEM) was set up for the National Tuberculosis Programme (NTP)
Summary
Multidrug-resistant tuberculosis (MDR-TB) is a significant threat to global healthcare systems and TB control. The global treatment success rates for MDR-TB and extensively drug-resistant TB (XDR-TB) were low at 57% and 26%, respectively [1, 2]. MDR-TB treatment is complicated, expensive, requires a combination of multiple anti-TB drugs, of which some are highly toxic, and some regimens last 20 months or more [2]. To have a comprehensive picture of adverse events (AEs) that MDR-TB patients sustained during the whole period of treatment, cohort event monitoring (CEM) was set up for the National Tuberculosis Programme (NTP). CEM was used to actively detect AEs during MDR-TB treatment, assess causality and improve the clinical management of the patients
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