Management of and risk factors related to hepatotoxicity during tuberculosis treatment

Babalik, Aylin; Arda, Hülya; Bakırcı, Nadi; Ağca, Sinem; Oruç, Korkmaz; Kızıltaş, Şule; Cetintas, Gulgun; Çalişir, Haluk C.

doi:10.5578/tt.3053

Cited by 25 publications

(22 citation statements)

References 10 publications

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“…4,5 Anti-tuberculosis drug-induced liver injury (ATLI) or anti-tuberculosis drug-induced hepatotoxicity is a common adverse reaction encountered by patients during the treatment period. 6,7 ATLI and other drug-related adverse reactions contribute to the treatment interruption, a prolonged disease course, and unfavorable outcomes. 8 Severe ATLI can lead to a fatality rate of 6-12% if the drug use continues after the onset of symptoms.…”

Section: Introductionmentioning

confidence: 99%

Preventive use of a hepatoprotectant against anti‐tuberculosis drug‐induced liver injury: A randomized controlled trial

Zhang

Pan²,

Peng

et al. 2016

J of Gastro and Hepatol

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Background and Aim: Hepatoprotectants are routinely prescribed in China to prevent anti-tuberculosis drug-induced liver injury (ATLI). However, their biological mechanismshave not yet been clearly demonstrated. This study aims to evaluate the preventive effects of Silybum marianum against drug-induced liver injury among tuberculosis patients and to provide clinical guidelines for tuberculosis management in China. Methods: A randomized controlled trial was performed in Jiangsu, China. Tuberculosis patients were randomly allocated to the experimental group (anti-tuberculosis therapy plus S. marianum capsule) or the control group (anti-tuberculosis therapy plus vitamin C tablet). The primary outcomes were the occurrence of probable and possible ATLI, the peak aspartate aminotransferase/alanine aminotransferase ratio and the maximum altered alkaline phosphatase or gamma-glutamyl transferase.Results: The final analysis comprised 183 cases in the experiment group and 187 cases in the control group. The risk of developing probable ATLI was not significantly different between the two groups. During the follow-up period, 43.72% of cases in the experiment group and 35.83% of cases in the control group were determined to have possible ATLI (relative risk = 1.23, 95% confidence interval: 0.94-1.54). When using a more strict definition of possible ATLI, the adjusted relative risk (95% confidence interval) was 1.76 (1.14-2.56). The risks of adverse drug reactions, prolonged treatment length, taking second-line tuberculosis drugs, and the clearance of tuberculosis bacteria were similar between the two groups. Conclusions: No significant preventive effect of silymarin was found for either lowering the risk of liver injury or boosting the positive outcomes. Worse, we even found a potential risk of liver damage caused by the hepatoprotectant.

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Section: Introductionmentioning

confidence: 99%

Preventive use of a hepatoprotectant against anti‐tuberculosis drug‐induced liver injury: A randomized controlled trial

Zhang

Pan²,

Peng

et al. 2016

J of Gastro and Hepatol

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“…The reported risk factors for DILI are old age, female gender, poor nutritional status, high alcohol consumption, pre-existing liver disease, hepatitis B and C infections, extensive tuberculosis hypoalbuminemia [28,29].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Drug Induced Liver Injury in Tuberculosis and Hepatitis Coinfection by Liver Fibrosis Index Score

Oa¹

2017

Austin J Gastroenterol

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“…A study performed in Turkey (n=1443) evaluated the association between comorbidities and hepatoxicity however they didn't find an increased risk (29).…”

Section: Discussionmentioning

confidence: 99%

Risk factors for hepatotoxicity in patients hospitalized for tuberculosis

et al. 2017

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Introduction:Combination therapy with four drugs (isoniazid, rifampicin, pyrazinamid and ethambutol) is the treatment of choice in tuberculosis but hepatotoxicity due to these drugs is an important medical concern. Therefore identification of patient groups with increased risk for antituberculosis therapy induced hepatotoxicity is crucial. Objective: To assess the rate of hepototoxicity due to antituberculosis drugs and to determine factors associated with hepatotoxicity in hospitalized tuberculosis patients. Methods: This retrospective cohort study included hospitalized patients with the diagnosis of tuberculosis during a ten year period. Only patients with microbiological (culture positive) or histopathological (presence of granulomatous reaction with caseification necrosis in the tissue) evidence of tuberculosis infection were included. Incidence of hepatotoxicity and the association of hepatotoxicity with known and unknown risk factors were investigated. Results: Sixty four patients (33 female-31 male; median age 48.0 years) were included into the study. Most of the patients had extrapulmonary tuberculosis (n=49). Antituberculosis therapy was started with four drugs in all patients and 7 patients developed hepatotoxicity. Age, gender, previous tuberculosis history, extent of tuberculosis, positive hepatitis B virus serology, diabetes mellitus and chronic renal insufficiency were not related with the development of hepatotoxicity. The presence of rheumatologic disease and chronic corticosteroid use was associated with increased risk of hepatotoxicity (p<0.01 and p=0.01, respectively). Conclusion:In this study we found that patients with rheumatologic diseases and patients on chronic corticosteroid treatment had increased risk for hepatotoxicity during antituberculosis therapy. These patients should be closely monitored for hepatotoxicity especially during the initial treatment phase.

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Management of and risk factors related to hepatotoxicity during tuberculosis treatment

Abstract: ÖZET

Cited by 25 publications

References 10 publications

Preventive use of a hepatoprotectant against anti‐tuberculosis drug‐induced liver injury: A randomized controlled trial

Preventive use of a hepatoprotectant against anti‐tuberculosis drug‐induced liver injury: A randomized controlled trial

Evaluation of Drug Induced Liver Injury in Tuberculosis and Hepatitis Coinfection by Liver Fibrosis Index Score

Risk factors for hepatotoxicity in patients hospitalized for tuberculosis

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