H Kunst1, K S Khan. 1. Department of Respiratory Medicine, Heartlands Hospital, Birmingham, UK. hkunst@doctors.org.uk
Abstract
OBJECTIVE: To determine the age-related risk of hepatotoxicity under currently recommended treatment regimens for latent tuberculosis (TB) infection (LTBI). METHODS: A systematic review of the MEDLINE and EMBASE databases (from database inception to 2008) was performed to determine the risk of isoniazid (INH) and/or rifampicin hepatotoxicity in LTBI treatment stratified by patient age. Study selection, study quality assessment and data extraction were performed using piloted proformas. Rate data were meta-analysed to generate summary rates with 95%CI within age-related subgroups using a random effects model. RESULTS: Seven relevant studies (18,610 participants, including 115 cases of hepatotoxicity) met the selection criteria. The median rate of hepatotoxicity was 1.8% (range 0.07-11.9). On average, rates were higher among those aged ≥ 35 years (1.7%, 95%CI 1.4-2.2) than those aged <35 years (0.2%, 95%CI 0.1-0.3). CONCLUSION: The rates of hepatotoxicity were low. Summary estimates of risks generated in this review can be used for counselling individuals for whom chemoprophylaxis is recommended. The use of INH for the treatment of LTBI is safe in older patients with clinical or biochemical monitoring.
OBJECTIVE: To determine the age-related risk of hepatotoxicity under currently recommended treatment regimens for latent tuberculosis (TB) infection (LTBI). METHODS: A systematic review of the MEDLINE and EMBASE databases (from database inception to 2008) was performed to determine the risk of isoniazid (INH) and/or rifampicinhepatotoxicity in LTBI treatment stratified by patient age. Study selection, study quality assessment and data extraction were performed using piloted proformas. Rate data were meta-analysed to generate summary rates with 95%CI within age-related subgroups using a random effects model. RESULTS: Seven relevant studies (18,610 participants, including 115 cases of hepatotoxicity) met the selection criteria. The median rate of hepatotoxicity was 1.8% (range 0.07-11.9). On average, rates were higher among those aged ≥ 35 years (1.7%, 95%CI 1.4-2.2) than those aged <35 years (0.2%, 95%CI 0.1-0.3). CONCLUSION: The rates of hepatotoxicity were low. Summary estimates of risks generated in this review can be used for counselling individuals for whom chemoprophylaxis is recommended. The use of INH for the treatment of LTBI is safe in older patients with clinical or biochemical monitoring.
Authors: Jennifer D Hosford; Michael E von Fricken; Michael Lauzardo; Myron Chang; Yunfeng Dai; Jennifer A Lyon; John Shuster; Kevin P Fennelly Journal: Tuberculosis (Edinb) Date: 2014-12-18 Impact factor: 3.131
Authors: I Pathmanathan; S Ahmedov; E Pevzner; G Anyalechi; S Modi; H Kirking; J S Cavanaugh Journal: Int J Tuberc Lung Dis Date: 2018-06-01 Impact factor: 2.373
Authors: Christiaan Mulder; Henk van Deutekom; Erik M Huisman; Sophie Toumanian; Ben F P J Koster; Wieneke Meijer-Veldman; Joke H van Loenhout-Rooyackers; Milo Appel; Sandra M Arend; Martien W Borgdorff; Frank van Leth Journal: Eur Respir J Date: 2012-04-10 Impact factor: 16.671