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Rafique S, Ahmad N, Khan S, Khan A, Atif M, Wahid A, Khan A, Waheed H. Frequency, management and impact of adverse events on treatment outcomes in patients with multidrug resistant tuberculosis in Balochistan, Pakistan. J Pharm Policy Pract 2024; 17:2332878. [PMID: 38572376 PMCID: PMC10989201 DOI: 10.1080/20523211.2024.2332878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Background Early detection, monitoring, and managing adverse events (AEs) are crucial in optimising treatment for multidrug-resistant tuberculosis (MDR-TB) patients. Objectives To investigate the incidence, factors, management, and impact of AEs on treatment outcomes in MDR-TB patients. Methods This study reviewed the medical records of 275 MDR-TB patients at Fatimah Jinnah Institute of Chest Diseases in Quetta, Pakistan. Patient information was collected using a designed data collection form. Mann-Whitney U and Kruskal-Wallis tests examined the difference in AEs occurrences based on patients' characteristics. Multiple binary logistic regression identified factors associated with unsuccessful outcomes, with statistical significance set at a p-value < 0.05. Results Almost all patients (99.6%) experienced at-least one AE (median = 4/patient, interquartile range:3-6). The most common were GI disturbance (95.3%), arthralgia (80.4%), body pain and headache (61.8%), ototoxicity (61.4%), psychiatric disturbance (44%), hypokalaemia (40.4%), dermatological reactions (26.2%) and hypothyroidism (21.5%). AEs led to treatment modification in 7.3% patients. Educated patients, those with a history of TB treatment, previous use and resistance to any second-line drug had significantly higher number of AEs. A total of 64.0% were declared cured, 3.6% completed treatment, 19.6% died and 12.7.9% were lost to follow-up. Patients' age of 41-60(OR = 9.225) and >60 years(OR = 23.481), baseline body weight of 31-60 kg(OR = 0.180), urban residence(OR = 0.296), and experiencing ototoxicity (OR = 0.258) and hypothyroidism (OR = 0.136) were significantly associated with unsuccessful treatment outcomes. Conclusion AEs were highly prevalent but did not negatively impact treatment outcomes. Patients at higher risk of developing AEs and unsuccessful outcomes should receive special attention for its early management.
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Affiliation(s)
- Sara Rafique
- Department of Pharmacy Practice, Faculty of Biological, Pharmaceutical and Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Nafees Ahmad
- Department of Pharmacy Practice, Faculty of Biological, Pharmaceutical and Health Sciences, University of Balochistan, Quetta, Pakistan
| | | | - Amjad Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Muhammad Atif
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Abdul Wahid
- Department of Pharmacy Practice, Faculty of Biological, Pharmaceutical and Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Asad Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Hira Waheed
- Department of Pharmacy Practice, Faculty of Biological, Pharmaceutical and Health Sciences, University of Balochistan, Quetta, Pakistan
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Dutta Gupta D, Keny SJ, Kakodkar UC. Study of adverse drug reactions during the treatment of drug resistant tuberculosis. Indian J Tuberc 2024; 71 Suppl 1:S136-S140. [PMID: 39067945 DOI: 10.1016/j.ijtb.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Pharmacovigilance entails monitoring of patients for timely detection of ADR and reporting them so that more information about drug safety can be obtained. This may help in the future for dose modification or alteration of regimen. In NTEP, ADSm (Active Drug Safety monitoring) is part of pharmacovigilance. In this study we shall be studying ADRs to Anti TB drugs in DRTB. METHODOLOGY This study is observational, retrospective and record based, of patients admitted from 2021 to 2023 in the DOTS ward of Respiratory Medicine Department of a tertiary care hospital in Goa. Data such as age, sex, regimen, date of AKT initiation and adverse effects documented has been noted and compiled. RESULTS ADRs have been tabulated in the form of tables. Statistical analysis is done to find out the commonest ADR, time when they are likely to occur, which age and gender are most likely affected and if there are any other associated risk factors for ADRs. CONCLUSION This study will enable in future to better monitor patients with regard to particular adverse drug reaction, patient safety and if needed to alter the regimen as early as possible.
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Affiliation(s)
- Diya Dutta Gupta
- Department of Respiratory Medicine, Goa Medical College, Bambolim, Goa, 403202, India.
| | - Sanjivani J Keny
- Department of Respiratory Medicine, Goa Medical College, Bambolim, Goa, 403202, India
| | - Uday C Kakodkar
- Department of Respiratory Medicine, Goa Medical College, Bambolim, Goa, 403202, India
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Tran Y, Tang D, Lo C, Macken O, Newall J, Bierbaum M, Gopinath B. Establishing multifactorial risk factors for adult-onset hearing loss: A systematic review with topic modelling and synthesis of epidemiological evidence. Prev Med 2024; 180:107882. [PMID: 38296002 DOI: 10.1016/j.ypmed.2024.107882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/24/2024] [Accepted: 01/27/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND This systematic review explores the multifaceted nature of risk factors contributing to adult-onset HL. The objective was to synthesise the most recent epidemiological evidence to generate pooled proportional incidences for the identified risk factors. METHODS We conducted an extensive search of electronic databases (MEDLINE, EMBASE, and psychINFO) for studies providing epidemiological evidence of risk factors associated with hearing loss. Topic modelling using Latent Dirichlet Allocation (LDA) was first conducted to determine how many risk factor themes were available from the papers. Data were analysed by calculating the pooled proportional incidence using a meta-analysis of proportions. RESULTS From the 72 studies reviewed, six key risk factor themes emerged through LDA topic modelling. The review identified ototoxicity, primarily caused by cancer treatments and antibiotics, infectious diseases like COVID-19, occupational noise exposure, lifestyle factors, health conditions, biological responses, and age progression as significant risk factors for HL. The highest proportional incidence was found with cancer-related ototoxicity at 55.4% (95%CI: 39.0-70.7), followed closely by ototoxicity from infectious diseases at 50.0% (95%CI: 28.5-71.5). This high proportional incidence suggests the need to explore less destructive therapies and proactively monitor hearing function during treatments. CONCLUSIONS The findings of this review, combined with the synthesis of epidemiological evidence, enhance our understanding of hearing loss (HL) pathogenesis and highlight potential areas for intervention, thereby paving the way for more effective prevention and management of adult-onset hearing loss in our ageing global population.
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Affiliation(s)
- Yvonne Tran
- Macquarie University Hearing Research Centre, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2109, Australia.
| | - Diana Tang
- Macquarie University Hearing Research Centre, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2109, Australia.
| | - Charles Lo
- Australian College of Applied Professions, Sydney, NSW 2000, Australia.
| | - Oonagh Macken
- Department of Linguistics, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2109, Australia.
| | - John Newall
- Department of Linguistics, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2109, Australia.
| | - Mia Bierbaum
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2109, Australia.
| | - Bamini Gopinath
- Macquarie University Hearing Research Centre, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2109, Australia.
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Katran ZY, Bulut İ, Babalık A, Keren M, Tepetam FM, Mersin SS, Örçen C, Yakut T, Yavuz D. Drug hypersensitivity in drug-resistant tuberculosis. World Allergy Organ J 2023; 16:100778. [PMID: 37251814 PMCID: PMC10213312 DOI: 10.1016/j.waojou.2023.100778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/03/2023] [Accepted: 04/14/2023] [Indexed: 05/31/2023] Open
Abstract
Objective To evaluate drug resıstant tuberculosis patients who developed drug hypersensitivity to antituberculosis drug. Methods This was a retrospective study. The primary aim of the study is to determine the demographic and clinical characteristics of patients who develop drug hypersensitivity in drug resistant tuberculosis patients. The secondary aim of the study is to examine the treatment results. Demographic features, tuberculosis diagnostic indicator, clinical signs of developing hypersensitivity reaction, reaction time, and treatment were evaluated. Results A total of 25 patients were included in the study. The prevalence of hypersensitivity in drug resistance patients was 11.9%. Twelve (48%) of the cases were women. Mean age (mean ± SD) was 37.24 ± 14.44 years; early type hypersensitivity reaction in 13 (52%). Three patients were isoniazid resistant; 19 patients were multidrug-resistant (MDR); 2 patients were pre-extensive drug resistant (Pre-XDR), 1 patient was extensive drug resistance (XDR) tuberculosis. The most common skin findings were maculopapular eruption and urticaria. But also we had seen ısole angıodema, urtıcarıa and angıoedema, erythema multıforme, lıchenoıd drug eruptıon and drug rash with eosinophilia and systemic symptoms. In patients who developed a hypersensitivity reaction, the responsible agent was identified in 14 cases in total. Among the drugs, pyrazinamide, ethambutol, moxifloxacin, amikacin, para amino salicylic, prothionamide, and cycloserine are the responsible agents. When evaluated in terms of treatment results, 15 (60%) patients successfully completed the treatment. Conclusion Our study is the first study in the literature that evaluated the drug hypersensitivity in drug resıstance tuberculosis patients. Drug hypersensitivity that develops with tuberculosis treatment may lead to discontinuation or change in treatment. İt can cause treatment failure, drug resistance, relapse, and even death. In resistant tuberculosis, the already existing resistance pattern may become more difficult to treat. Success can be achieved with the right management in these patients who have few treatment options, more drug side effects, and high treatment failure rates. The established regimen should be curative and prevent recurrence.
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Affiliation(s)
- Zeynep Yegin Katran
- Department of Allergy and Immunology, University of Health Sciences, Süreyyapaşa Training and Research Hospital, Istanbul, Turkey
| | - İsmet Bulut
- Department of Allergy and Immunology, University of Health Sciences, Süreyyapaşa Training and Research Hospital, Istanbul, Turkey
| | - Aylin Babalık
- Department of Chest Diseases, University of Health Sciences, Süreyyapaşa Training and Research Hospital, İstanbul, Turkey
| | - Metin Keren
- Department of Allergy and Immunology, University of Health Sciences, Süreyyapaşa Training and Research Hospital, Istanbul, Turkey
| | - Fatma Merve Tepetam
- Department of Allergy and Immunology, University of Health Sciences, Süreyyapaşa Training and Research Hospital, Istanbul, Turkey
| | - Selver Seda Mersin
- Department of Allergy and Immunology, Dr Ersin Arslan Training and Research Hospital, Gazıantep, Turkey
| | - Cihan Örçen
- Department of Allergy and Immunology, Derınce Training and Research Hospital, Kocaeli, Turkey
| | - Tuğçe Yakut
- Department of Allergy and Immunology, Diyarbakır Training and Research Hospital, Diyarbakır, Turkey
| | - Dilek Yavuz
- Department of Allergy and Immunology, University of Health Sciences, Süreyyapaşa Training and Research Hospital, Istanbul, Turkey
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Duga AL, Salvo F, Kay A, Figueras A. Safety Profile of Medicines Used for the Treatment of Drug-Resistant Tuberculosis: A Descriptive Study Based on the WHO Database (VigiBase ®). Antibiotics (Basel) 2023; 12:antibiotics12050811. [PMID: 37237714 DOI: 10.3390/antibiotics12050811] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The introduction of new drugs that increase the usage of repurposed medicines for managing drug-resistant tuberculosis (DR-TB) comes with challenges of understanding, properly managing, and predicting adverse drug reactions (ADRs). In addition to the health consequences of ADRs for the individual, ADRs can reduce treatment adherence, thus contributing to resistance. This study aimed to describe the magnitude and characteristics of DR-TB-related ADRs through an analysis of ADRs reported to the WHO database (VigiBase) in the period from January 2018 to December 2020. METHODS A descriptive analysis was performed on selected reports from VigiBase on the basis of medicine-potential ADR pairs. The ADRs were stratified by sex, age group, reporting country, seriousness, outcome of the reaction, and dechallenge and rechallenge. RESULTS In total, 25 medicines reported to be suspected individual medicines or as a fixed-dose combination in the study period were included the study. Pyrazinamide (n = 836; 11.2%) was the most commonly reported medicine associated with ADRs, followed by ethionamide (n = 783; 10.5%) and cycloserine (n = 696; 9.3%). From the report included in this analysis, 2334 (31.2%) required complete withdrawal of the suspected medicine(s), followed by reduction of the dose (77; 1.0%) and an increased dose (4; 0.1%). Almost half of the reports were serious ADRs mainly caused by bedaquiline, delamanid, clofazimine, linezolid, and cycloserine that are the backbone of the DR-TB treatment currently in use. CONCLUSIONS A third of the reports required medication withdrawal, which impacts treatment adherence and ultimately leads to drug resistance. Additionally, more than 40% of the reports indicated that ADRs appeared two months after the commencement of treatment, thus it's important to remain alert for the potential ADRs for the entire duration of the treatment.
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Affiliation(s)
- Alemayehu Lelisa Duga
- Doctoral School Societies, Politics, Public Health, Pharmacoepidemiology and Pharmacovigilance, University of Bordeaux, 33300 Bordeaux, France
- National Pharmacovigilance Center, Eswatini Ministry of Health, Mbabane H100, Eswatini
- Baylor College of Medicine Children's Foundation-Eswatini, Mbabane H100, Eswatini
| | - Francesco Salvo
- Doctoral School Societies, Politics, Public Health, Pharmacoepidemiology and Pharmacovigilance, University of Bordeaux, 33300 Bordeaux, France
| | - Alexander Kay
- Baylor College of Medicine Children's Foundation-Eswatini, Mbabane H100, Eswatini
- Baylor College of Medicine, Houston, TX 77030, USA
| | - Albert Figueras
- Doctoral School Societies, Politics, Public Health, Pharmacoepidemiology and Pharmacovigilance, University of Bordeaux, 33300 Bordeaux, France
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