The clinical impact of drug-induced hepatotoxicity on anti-tuberculosis therapy: a case control study

Jin Hwa Song,Tae Yun Park,Jung-Kyu Lee,Eun Young Heo,Deog Kyeom Kim,Hee Soon Chung,Seo-Young Yoon

doi:10.1186/s12931-019-1256-y

Abstract

BackgroundThere are limited data available on whether drug-induced hepatotoxicity (DIH) affects the clinical outcomes of tuberculosis (TB) treatment. We explored the effects of DIH on the clinical course and outcomes of pulmonary TB.MethodsIn this retrospective cohort study, we included patients with culture-proven pulmonary TB treated in a tertiary hospital from 2013 to 2016. DIH was defined as proposed by the official American Thoracic Society statement. We compared the clinical outcomes of DIH and non-DIH patients.ResultsBetween January 1, 2013 and December 31, 2016, a total of 168 TB patients were included, and 20 (11.9%) were diagnosed with DIH. These patients were significantly older, had a higher Charlson Comorbidity Index score, exhibited more chronic liver disease, included more chronic alcoholics, and had a lower body mass index than non-DIH patients. We found no significant differences between DIH and non-DIH patients in the 2-month sputum culture conversion rate, the time to sputum culture conversion, treatment outcomes, or total treatment duration. However, the ratio of treatment interruption time to total treatment duration and the proportion of hepatotonic users were significantly higher among DIH patients.ConclusionDIH development during TB treatment does not significantly affect the clinical outcomes of pulmonary TB. However, treatment interruption caused by DIH may increase the risks of future relapse and acquired resistance. Further study is needed.

Highlights

There are limited data available on whether drug-induced hepatotoxicity (DIH) affects the clinical outcomes of tuberculosis (TB) treatment
We explored whether DIH development during TB treatment could affect the clinical course and outcomes of TB
Twenty patients developed DIH (11.9%); these patients were older than non-DIH patients (62.9 ± 17.1 vs. 52.1 ± 19.2 years; P = 0.018), had a significantly higher Charlson Comorbidity Index score (0.80 ± 0.83 vs. 0.43 ± 0.63; P = 0.042), had a more extensive history of chronic liver disease (25 vs. 6.1%, P = 0.004), and were more commonly chronic alcoholics (15 vs. 3.4%; P = 0.022)

Summary

Introduction

There are limited data available on whether drug-induced hepatotoxicity (DIH) affects the clinical outcomes of tuberculosis (TB) treatment. We explored the effects of DIH on the clinical course and outcomes of pulmonary TB. TB is the most common cause of death from infectious disease; 6.30 million new TB cases and 1.7 million TB deaths were reported globally in 2016 [1]. Drug-induced hepatotoxicity (DIH) is one of the most common side-effects requiring drug interruption. Song et al Respiratory Research (2019) 20:283 on the causative agents, mechanisms, and risk factors; few studies have explored the clinical outcomes of TB treatment in patients with DIH [11,12,13,14].

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