Adverse Effects of Drugs used in the treatment of multi-drug resistant tuberculosis

Abstract

Introduction Multi-drug resistant tuberculosis (MDR-TB) remains a challenge despite shorter treatment regimes, with significant adverse effects that can impact psychological and physical aspects of health, potentially affecting treatment outcomes. Methods A retrospective cohort study was completed at an East London teaching hospital including patients with confirmed MDR-TB or receiving MDR-TB drugs between 2010 and 2023. Results We evaluated 32 patients who were started on MDRTB treatment. Thirty patients had MDR-TB and two patients were on MDR treatment due to drug intolerance. Nineteen patients (59%) were male, median participant age was 39 years (IQR=20). Twenty-six patients out of 32 were migrants. Nineteen patients (59%) had pulmonary or pleural MDR-TB, eight patients (25%) had lymph node MDR-TB, with the remainder (16%) having MDR-TB in other sites including the renal system, skin, central nervous system, thyroid gland and/ or joints. Twenty-eight patients were initiated on current WHO recommended treatment regimens for MDR-TB. Four patients were commenced on standard TB treatment regimes prior to being switched. Across our cohort, 24 patients (75%) developed an adverse effect to one or more drugs resulting in a treatment change. The most common drugs causing adverse effects resulting in a treatment change were linezolid (16/24), levofloxacin (5/24), pyrazinamide (10/24) and cycloserine (6/24). Linezolid was predominantly stopped (62%) due to symptoms suggestive of peripheral neuropathy. Other adverse events that resulted in treatment change included a metallic taste, glossitis, mood disturbance, anaemia, or serotonin syndrome. Levofloxacin was stopped in five patients due to joint pain and/or tendinopathies. Pyrazinamide was stopped in ten patients due to elevated urate levels and clinical symptoms of gout. Cycloserine was stopped in six patients due to low mood and suicidal ideations. Conclusion Despite newer more effective MDR-TB regimens, patients on MDR treatment continue to have significant side effects and should have access to shorter drug regimens.