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Song I, Kim M, Choi H, Kim JH, Lim KH, Yoon HS, Rah YC, Park E, Im GJ, Song JJ, Chae SW, Choi J. Hydrophilic and lipophilic statin use and risk of hearing loss in hyperlipidemia using a Common Data Model: multicenter cohort study. Sci Rep 2023; 13:12373. [PMID: 37524760 PMCID: PMC10390480 DOI: 10.1038/s41598-023-39316-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/23/2023] [Indexed: 08/02/2023] Open
Abstract
Hearing impairment, the third largest health burden worldwide, currently lacks definitive treatments or preventive drugs. This study compared the effects of hydrophilic and lipophilic statin on hearing loss using a common database model. This retrospective multicenter study was conducted in three hospitals in South Korea (Anam, Guro, Ansan). We enrolled patients with hyperlipidemia with an initial hearing loss diagnosis. Data were collected during January 1, 2022-December 31, 2021 using the Observational Health Data Science and Informatics open-source software and Common Data Model database. The primary outcome was the occurrence of first-time hearing loss following a hyperlipidemia diagnosis, as documented in the Common Data Model cohort database. The measures of interest were hearing loss risk between hydrophilic and lipophilic statin use. Variables were compared using propensity score matching, Cox proportional regression, and meta-analysis. Among 37,322 patients with hyperlipidemia, 13,751 (7669 men and 6082 women) and 23,631 (11,390 men and 12,241 women) were treated with hydrophilic and lipophilic statins, respectively. After propensity score matching, according to the Kaplan-Meier curve, hearing loss risk did not significantly differ among the hospitals. The hazard ratio (HR) of the male patients from Anam (0.29, [95% confidence interval (CI), 0.05-1.51]), Guro (HR, 0.56, [95% CI 0.18-1.71]), and Ansan (hazard ratio, 0.29, [95% CI 0.05-1.51]) hospitals were analyzed using Cox proportional regression. Overall effect size (HR, 0.40, [95% CI 0.18-0.91]) was estimated using meta-analysis, which indicated that hearing loss risk among hydrophilic statin users was less than that among lipophilic statin users and was statistically significant. Men in the hydrophilic statin group had a lower risk of hearing impairment than those in the lipophilic statin group.
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Affiliation(s)
- Insik Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Minjin Kim
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
- Biomedical Research Center, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Hangseok Choi
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
- Biomedical Research Center, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Jeong Hwan Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Kang Hyeon Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Hee Soo Yoon
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Yoon Chan Rah
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Euyhyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Gi Jung Im
- Department of Otorhinolaryngology-Head and Neck Surgery, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae-Jun Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sung-Won Chae
- Department of Otorhinolaryngology-Head and Neck Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - June Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.
- Department of Medical Informatics, Korea University College of Medicine, Seoul, Republic of Korea.
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Sauer SM, Mitnick CD, Khan U, Hewison C, Bastard M, Holtzman D, Law S, Khan M, Padayachee S, Ahmed S, Isani AK, Krisnanda A, Vilbrun SC, Bektasov S, Kumsa A, Docteur W, Tintaya K, McNicol M, Atshemyan H, Voynilo T, Thwe TT, Seung K, Rich M, Huerga H, Khan P, Franke M. Estimating post-treatment recurrence after multidrug-resistant tuberculosis treatment among patients with and without HIV: the impact of assumptions about death and missing follow-up. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.24.23290472. [PMID: 37398252 PMCID: PMC10312883 DOI: 10.1101/2023.05.24.23290472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Background Quantification of recurrence risk following successful treatment is crucial to evaluating regimens for multidrug- or rifampicin-resistant (MDR/RR) tuberculosis (TB). However, such analyses are complicated when some patients die or become lost during post-treatment-follow-up. Methods We analyzed data on 1,991 patients who successfully completed a longer MDR/RR-TB regimen containing bedaquiline and/or delamanid between 2015 and 2018 in 16 countries. Using five approaches for handling post-treatment deaths, we estimated the six-month post-treatment TB recurrence risk overall, and by HIV status. We used inverse-probability-weighting to account for patients with missing follow-up and investigated the impact of potential bias from excluding these patients without applying inverse-probability weights. Results The estimated TB recurrence risk was 6.6 per 1000 (95% confidence interval (CI):3.2,11.2) when deaths were handled as non-recurrences, and 6.7 per 1000 (95% CI:2.8,12.2) when deaths were censored and inverse-probability weights were applied to account for the excluded deaths. The estimated risk of composite recurrence outcomes were 24.2 (95% CI:14.1,37.0), 10.5 (95% CI:5.6,16.6), and 7.8 (95% CI:3.9,13.2) per 1000 for recurrence or 1) any death, 2) death with unknown or TB-related cause, 3) TB-related death, respectively. Corresponding relative risks for HIV status varied in direction and magnitude. Exclusion of patients with missing follow-up without inverse-probability-weighting had a small but apparent impact on estimates. Conclusion The estimated six-month TB recurrence risk was low, and the association with HIV status was inconclusive due to few recurrence events. Estimation of post-treatment recurrence will be enhanced by explicit assumptions about deaths and appropriate adjustment for missing follow-up data.
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Kim M, Park DH, Choi H, Song I, Lim KH, Yoon HS, Rah YC, Choi J. A Multicenter Cohort Study on the Association between Metformin Use and Hearing Loss in Patients with Type 2 Diabetes Mellitus Using a Common Data Model. J Clin Med 2023; 12:jcm12093145. [PMID: 37176586 PMCID: PMC10179543 DOI: 10.3390/jcm12093145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
We attempted to explore the association between metformin use and hearing loss in in a large-scale study. This retrospective multicenter cohort study assessed the data of patients with type 2 diabetes mellitus (DM) aged over 40 years using the Observational Health Data Science and Informatics open-source software and the Common Data Model database from 1 January 2002 to 31 December 2019. Each participant was selected using the ICD-10-CM diagnosis code E11 for type 2 DM with sensorineural hearing loss. The participants were divided into metformin and non-metformin users. The outcome measure was the first occurrence of hearing loss after the diagnosis of DM as measured by the CDM cohort study. A total of 80,596 patients, including 46,152 metformin users and 34,444 non-metformin users from three hospitals were assessed. After calibration, we compared the risk of hearing loss using Kaplan-Meier curves, and found significant differences between the groups. The calibrated hazard ratio in the three hospitals (0.79 [95% confidence interval, 0.57-1.12]) was summarized. These findings suggest that the probability of hearing loss-free survival in the metformin user group is higher than that in the non-metformin user group.
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Affiliation(s)
- Minjin Kim
- Department of Biostatistics, Korea University College of Medicine, Seoul 02842, Republic of Korea
- Medical Science Research Center, Korea University Ansan Hospital, Ansan 15355, Republic of Korea
| | - Dong Heun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea
| | - Hangseok Choi
- Department of Biostatistics, Korea University College of Medicine, Seoul 02842, Republic of Korea
- Medical Science Research Center, Korea University Ansan Hospital, Ansan 15355, Republic of Korea
| | - Insik Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea
| | - Kang Hyeon Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea
| | - Hee Soo Yoon
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea
| | - Yoon Chan Rah
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea
| | - June Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea
- Department of Medical Informatics, Korea University College of Medicine, Seoul 02842, Republic of Korea
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Mpoh MM, Deli V, Daniel TT, Salvo F. Safety of antituberculosis agents used for multidrug-resistant tuberculosis among patients attending the Jamot Hospital of Yaounde, Cameroon. Int J Mycobacteriol 2023; 12:168-174. [PMID: 37338479 DOI: 10.4103/ijmy.ijmy_88_23] [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] [Indexed: 06/21/2023] Open
Abstract
Background Recognized in 1994 as a global emergency by the World Health Organization, tuberculosis (TB) remains an ongoing health threat. In Cameroon, the mortality rate is estimated at 2.9%. Treatment of multidrug-resistant TB (MDR-TB) defined as the resistance to the two most effective antiTB drugs, and requires therapy of more than 7 drugs taken on a daily basis during 9-12 months. This study aimed to evaluate the safety profile of treatment regimens used for MDR-TB at Jamot Hospital of Yaounde (JHY). Methods This was a retrospective cohort study of patients treated for MDR-TB at HJY from January 1, 2017, to December 31, 2019. Patients characteristics of the cohort, drugs regimen were collected and described. All possible adverse drug reactions (ADR) were described clinically and by severity grade. Results During the study period, 107 patients were included, and 96 (89.7%) experienced at least one ADR. Most parts of the patients (90) experienced mild or moderate ADR. Hearing loss was the most frequent ADR, and led mostly in aminoglycosides dose reduction (n = 30, 96.7%). Gastrointestinal events were commonly observed during the study period. Conclusion Our findings suggested that ototoxicity was a prominent safety issue during the study period. The implementation of the new short treatment regimen could be effective in reducing the burden of ototoxicity among MDR-TB patients. Nevertheless, new safety issues could emerge.
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Affiliation(s)
- Maurice Mbwe Mpoh
- Inserm, BPH, U1219 Team AHeaD, University of Bordeaux, Bordeaux, France; Directorate of Pharmacy, Drugs and Laboratories, Ministry of Public Health; Cameroon Drug Safety, Research Team, Yaounde, Cameroon
| | - Vandi Deli
- Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Tollo Tollo Daniel
- Section of Laboratory and Pharmacy, National Tuberculosis Control Program, Ministry of Public Health, Yaounde, Cameroon
| | - Francesco Salvo
- Inserm, BPH, U1219 Team AHeaD, University of Bordeaux; Department of Medical Pharmacology, Bordeaux University Hospital, Bordeaux, France
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Stevenson LJ, Biagio-de Jager L, Graham MA, Swanepoel DW. Extended High-Frequency Audiometry for Ototoxicity Monitoring: A Longitudinal Evaluation of Drug-Resistant Tuberculosis Treatment. Am J Audiol 2023; 32:70-80. [PMID: 36490390 DOI: 10.1044/2022_aja-22-00039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The aim of this study was to describe extended high-frequency (EHF) pure-tone audiometry monitoring of ototoxicity in a longitudinal treatment program for drug-resistant tuberculosis (DRTB). METHOD This was a retrospective record review of longitudinal conventional (0.25-8 kHz) and EHF (9-16 kHz) audiometry for ototoxicity monitoring of DRTB patients undergoing treatment at community-based clinics between 2013 and 2017. Data from 69 patients with an average age of 37.9 years (SD = 11.2, range: 16.0-63.8 years) were included. Patients were assessed by primary health care audiologists (87%) or community health workers (13%) using portable audiological equipment. The average length of time between initial and exit assessments was 84.6 days (SD = 74.2, range: 2-335 days). RESULTS EHF ototoxicity of a mild or greater degree of hearing loss (> 25 dB HL in one or both ears across frequencies) was evident in 85.5% of patients' posttreatment, compared with 47.8% of patients across conventional frequencies. EHF audiometry demonstrated an ototoxic shift (American Speech-Language-Hearing Association criteria) in 56.5% of cases compared with 31.9% when only conventional audiometry was considered. Mean hearing deterioration for patients was significant across EHFs (9-16 kHz) bilaterally (p < .05). Absent EHF thresholds at the initial assessment, owing to maximum output limits, was a limitation that occurred most frequently at 16 kHz (17.4%, 24/138). CONCLUSIONS EHF audiometry is most sensitive for the early detection of ototoxicity and should be included in monitoring programs. Clinical ototoxicity monitoring protocols should consider shortened assessment approaches that target frequencies most sensitive to ototoxicity, including EHFs. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21651242.
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Affiliation(s)
- Lucia Jane Stevenson
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, South Africa
| | - Leigh Biagio-de Jager
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, South Africa
| | - Marien Alet Graham
- Department of Science, Mathematics and Technology Education, Faculty of Education, University of Pretoria, South Africa
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, South Africa.,Ear Science Institute Australia, Perth, Western Australia
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Akalu TY, Clements ACA, Baraki AG, Alene KA. Protocol for a systematic review of long-term physical sequelae and financial burden of multidrug-resistant and extensively drug-resistant tuberculosis. PLoS One 2023; 18:e0285404. [PMID: 37186609 PMCID: PMC10184907 DOI: 10.1371/journal.pone.0285404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/31/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Multidrug resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) are major public health threats that are significant causes of physical sequelae and financial consequences for infected people. Treatment for MDR- and XDR-TB are more toxic and take longer duration than for drug-susceptible-TB. As a result, the long-term sequelae are thought to be more common among patients with MDR- and XDR-TB than drug-susceptible-TB, but this is yet to be quantified. Hence, the aim of this systematic review and meta-analysis is to quantify the global burden and types of long-term physical sequelae and financial burden associated with both MDR- and XDR-TB. METHOD AND ANALYSIS We will search CINHAL, MEDLINE, Embase, Scopus, and Web of science for studies that report physical and financial sequelae associated with rifampicin-resistant (RR), MDR- and XDR-TB or their treatments. The search will be conducted without time, language, and place restrictions. A random-effects meta-analysis will be conducted to estimate the pooled prevalence of each physical sequela. Heterogeneity will be measured using the Higgins I2 statistics. We will assess publication bias visually using the funnel plot and statistically using Egger's test. Adjustments for publication basis will be made using Tweedie's and Duval Trim and Fill analysis. ETHICS AND DISSEMINATION Since the study is based on published evidence, ethics approval is not required. The findings of the systematic review will be presented at various conferences and will be published in a peer-reviewed journal. PROTOCOL REGISTRATION The protocol is published in the PROSPERO with registration number CRD42021250909.
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Affiliation(s)
- Temesgen Yihunie Akalu
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Archie C A Clements
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom
| | | | - Kefyalew Addis Alene
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Tapfuma KI, Nyambo K, Adu-Amankwaah F, Baatjies L, Smith L, Allie N, Keyster M, Loxton AG, Ngxande M, Malgas-Enus R, Mavumengwana V. Antimycobacterial activity and molecular docking of methanolic extracts and compounds of marine fungi from Saldanha and False Bays, South Africa. Heliyon 2022; 8:e12406. [PMID: 36582695 PMCID: PMC9793266 DOI: 10.1016/j.heliyon.2022.e12406] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 10/18/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
The number and diversity of drugs in the tuberculosis (TB) drug development process has increased over the years, yet the attrition rate remains very high, signaling the need for continued research in drug discovery. In this study, crude secondary metabolites from marine fungi associated with ascidians collected from Saldanha and False Bays (South Africa) were investigated for antimycobacterial activity. Isolation of fungi was performed by sectioning thin inner-tissues of ascidians and spreading them over potato dextrose agar (PDA). Solid state fermentation of fungal isolates on PDA was then performed for 28 days to allow production of secondary metabolites. Afterwards, PDA cultures were dried and solid-liquid extraction using methanol was performed to extract fungal metabolites. Profiling of metabolites was performed using untargeted liquid chromatography quadrupole time-of-flight tandem mass spectrometry (LC-QTOF-MS/MS). The broth microdilution method was used to determine antimycobacterial activity against Mycobacterium smegmatis mc2155 and Mycobacterium tuberculosis H37Rv, while in silico flexible docking was performed on selected target proteins from M. tuberculosis. A total of 16 ascidians were sampled and 46 fungi were isolated. Only 32 fungal isolates were sequenced, and their sequences submitted to GenBank to obtain accession numbers. Metabolite profiling of 6 selected fungal extracts resulted in the identification of 65 metabolites. The most interesting extract was that of Clonostachys rogersoniana MGK33 which inhibited Mycobacterium smegmatis mc2155 and Mycobacterium tuberculosis H37Rv growth with minimum inhibitory concentrations (MICs) of 0.125 and 0.2 mg/mL, respectively. These results were in accordance with those from in silico molecular docking studies which showed that bionectin F produced by C. rogersoniana MGK33 is a potential inhibitor of M. tuberculosis β-ketoacyl-acyl carrier protein reductase (MabA, PDB ID = 1UZN), with the docking score observed as -11.17 kcal/mol. These findings provided evidence to conclude that metabolites from marine-derived fungi are potential sources of bioactive metabolites with antimycobacterial activity. Even though in silico studies showed that bionectin F is a potent inhibitor of an essential enzyme, MabA, the results should be validated by performing purification of bionectin F from C. rogersoniana MGK33 and in vitro assays against MabA and whole cells (M. tuberculosis).
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Affiliation(s)
- Kudzanai Ian Tapfuma
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kudakwashe Nyambo
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Francis Adu-Amankwaah
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lucinda Baatjies
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Liezel Smith
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nasiema Allie
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marshall Keyster
- Environmental Biotechnology Laboratory (EBL), Department of Biotechnology, University of the Western Cape, Cape Town, South Africa
| | - Andre G. Loxton
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Mkhuseli Ngxande
- Computer Science Division, Department of Mathematical Sciences, Faculty of Science University of Stellenbosch, Matieland, South Africa
| | - Rehana Malgas-Enus
- Department of Chemistry and Polymer Science, Faculty of Science, University of Stellenbosch, Matieland, South Africa
| | - Vuyo Mavumengwana
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,Corresponding author.
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Kuper H, Heydt P, Davey C. A focus on disability is necessary to achieve HIV epidemic control. THE LANCET HIV 2022; 9:e293-e298. [DOI: 10.1016/s2352-3018(21)00345-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/30/2021] [Accepted: 12/13/2021] [Indexed: 10/18/2022]
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Stevenson LJ, Biagio-de Jager L, Graham MA, Swanepoel DW. A longitudinal community-based ototoxicity monitoring programme and treatment effects for drug-resistant tuberculosis treatment, Western Cape. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2022; 69:e1-e13. [PMID: 35384675 PMCID: PMC8991219 DOI: 10.4102/sajcd.v69i1.886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/01/2022] [Accepted: 02/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background South Africa has a high burden of drug-resistant tuberculosis (DRTB) and until recently, ototoxic aminoglycosides were predominant in treatment regimens. Community-based ototoxicity monitoring programmes (OMPs) have been implemented for early detection of hearing loss and increased patient access. Objectives A longitudinal study was conducted to describe the service delivery characteristics of a community-based OMP for DRTB patients facilitated by CHWs as well as observed ototoxic hearing loss in this population. Method A descriptive retrospective record review of longitudinal ototoxicity monitoring of 194 DRTB patients undergoing treatment at community-based clinics in the city of Cape Town between 2013 and 2017. Results Follow-up rates between consecutive monitoring assessments reached as high as 80.6% for patients assessed by CHWs. Few patients (14.2% – 32.6%) were assessed with the regularity (≥ 6 assessments) and frequency required for effective ototoxicity monitoring, with assessments conducted, on average, every 53.4–64.3 days. Following DRTB treatment, 51.5% of patients presented with a significant ototoxic shift meeting one or more of the American Speech-Language-Hearing Association (ASHA) criteria. Deterioration in hearing thresholds was bilateral and most pronounced at high frequencies (4 kHz – 8 kHz). The presence of pre-existing hearing loss, human immunodeficiency virus co-infection and a history of noise exposure were significant predictors of ototoxicity in patients. Conclusion DRTB treatment with kanamycin resulted in significant deterioration of hearing longitudinally, predominantly at high frequencies. With ongoing training and supportive supervision, CHWs can facilitate community-based ototoxicity monitoring of DRTB patients. Current protocols and guidelines may require reassessment for appropriate community-based ototoxicity monitoring.
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Affiliation(s)
- Lucia J Stevenson
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria.
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Nie Q, Tao L, Li Y, Chen N, Chen H, Zhou Y, Wang Y, Chen H, Tang Q, Wang X, Huang C, Yang C. High-dose gatifloxacin-based shorter treatment regimens for MDR/RR-TB. Int J Infect Dis 2021; 115:142-148. [PMID: 34861398 DOI: 10.1016/j.ijid.2021.11.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 01/18/2023] Open
Abstract
SETTING The shorter treatment regimen (STR) for multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB) has achieved successful outcomes in many countries. However, there are few studies on high-dose gatifloxacin-based STR with adverse drug reactions (ADRs) and management. DESIGN A prospective observational study was conducted with MDR/RR-TB patients who were treated with a standardized 9 or 12 - month regimen: including gatifloxacin (Gfx), clofazimine (Cfz), ethambutol (EMB), and pyrazinamide (PZA), and supplemented by amikacin (Am), isoniazid (INH), and prothionamide (Pto) during an intensive phase of 4 or 6 - month. Monitored ADRs monthly until treatment completion and then followed up every three months for one year. RESULTS Among the 42 eligible patients, 35 (83.3%) completed treatment successfully, 1 (2.4%) lost to follow-up (LTFU), and 6 (14.3%) failed due to ADRs, with no death. The most important ADR was drug-induced liver damage, which occurred in 24 out of 42 (57.1%) patients and resulted in 4 (9.5%) failed treatments and 4 (9.5%) adjusted treatments. QT interval prolongation occurred in 17 out of 42 (40.5%) patients, 9 (21.4%) of them with the corrected QT interval according to Fridericia (QTcF) > 500 ms resulting in 7 (16.7%) adjusted treatments. CONCLUSIONS This study confirmed the effectiveness of the high-dose gatifloxacin-based STR but severe ADRs, especially hepatotoxicity and QT interval prolongation should never be ignored.
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Affiliation(s)
- Qi Nie
- College of Life Sciences and Health, Wuhan University of Science and Technology, Hubei, China; Department of MDR/RR-TB, Wuhan Jinyintan Hospital, Hubei, China
| | - Lixuan Tao
- Emergency Department, Puren Hospital Affiliated to Wuhan University of science and technology, Hubei, China
| | - Yingying Li
- Wuhan Jinyintan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Nanshan Chen
- Department of MDR/RR-TB, Wuhan Jinyintan Hospital, Hubei, China
| | - Hua Chen
- Department of MDR/RR-TB, Wuhan Jinyintan Hospital, Hubei, China
| | - Yong Zhou
- Department of MDR/RR-TB, Wuhan Jinyintan Hospital, Hubei, China
| | - Yanqiu Wang
- Department of MDR/RR-TB, Wuhan Jinyintan Hospital, Hubei, China
| | - Huidong Chen
- Department of Interventional therapy, Wuhan Jinyintan Hospital, Hubei, China
| | - Qiuping Tang
- Department of MDR/RR-TB, Wuhan Jinyintan Hospital, Hubei, China
| | - Xianguang Wang
- Department of MDR/RR-TB, Wuhan Jinyintan Hospital, Hubei, China.
| | - Chaolin Huang
- Department of MDR/RR-TB, Wuhan Jinyintan Hospital, Hubei, China.
| | - Chengfeng Yang
- Hubei Provincial Center for Disease Control and Prevention, China.
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11
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Coffin AB, Boney R, Hill J, Tian C, Steyger PS. Detecting Novel Ototoxins and Potentiation of Ototoxicity by Disease Settings. Front Neurol 2021; 12:725566. [PMID: 34489859 PMCID: PMC8418111 DOI: 10.3389/fneur.2021.725566] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/22/2021] [Indexed: 12/24/2022] Open
Abstract
Over 100 drugs and chemicals are associated with permanent hearing loss, tinnitus, and vestibular deficits, collectively known as ototoxicity. The ototoxic potential of drugs is rarely assessed in pre-clinical drug development or during clinical trials, so this debilitating side-effect is often discovered as patients begin to report hearing loss. Furthermore, drug-induced ototoxicity in adults, and particularly in elderly patients, may go unrecognized due to hearing loss from a variety of etiologies because of a lack of baseline assessments immediately prior to novel therapeutic treatment. During the current pandemic, there is an intense effort to identify new drugs or repurpose FDA-approved drugs to treat COVID-19. Several potential COVID-19 therapeutics are known ototoxins, including chloroquine (CQ) and lopinavir-ritonavir, demonstrating the necessity to identify ototoxic potential in existing and novel medicines. Furthermore, several factors are emerging as potentiators of ototoxicity, such as inflammation (a hallmark of COVID-19), genetic polymorphisms, and ototoxic synergy with co-therapeutics, increasing the necessity to evaluate a drug's potential to induce ototoxicity under varying conditions. Here, we review the potential of COVID-19 therapies to induce ototoxicity and factors that may compound their ototoxic effects. We then discuss two models for rapidly detecting the potential for ototoxicity: mammalian auditory cell lines and the larval zebrafish lateral line. These models offer considerable value for pre-clinical drug development, including development of COVID-19 therapies. Finally, we show the validity of in silico screening for ototoxic potential using a computational model that compares structural similarity of compounds of interest with a database of known ototoxins and non-ototoxins. Preclinical screening at in silico, in vitro, and in vivo levels can provide an earlier indication of the potential for ototoxicity and identify the subset of candidate therapeutics for treating COVID-19 that need to be monitored for ototoxicity as for other widely-used clinical therapeutics, like aminoglycosides and cisplatin.
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Affiliation(s)
| | | | - Jordan Hill
- Washington State University Vancouver, Vancouver, WA, United States
| | - Cong Tian
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE, United States
| | - Peter S. Steyger
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE, United States
- National Center for Rehabilitative Auditory Research, Portland, OR, United States
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12
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Khan PY, Franke MF, Hewison C, Seung KJ, Huerga H, Atwood S, Ahmed S, Khan M, Sultana T, Manzur-Ul-Alam M, Vo LNQ, Lecca L, Yae K, Kozhabekov S, Tamirat M, Gelin A, Vilbrun SC, Kikvidze M, Faqirzai J, Kadyrov A, Skrahina A, Mesic A, Avagyan N, Bastard M, Rich ML, Khan U, Mitnick CD. All-oral longer regimens are effective for the management of multidrug resistant tuberculosis in high burden settings. Eur Respir J 2021; 59:13993003.04345-2020. [PMID: 34140298 DOI: 10.1183/13993003.04345-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/31/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Recent World Health Organisation guidance on drug-resistant tuberculosis treatment de-prioritised injectable agents, in use for decades, and endorsed all-oral longer regimens. However, questions remain about the role of the injectable agent, particularly in the context of regimens using new and repurposed drugs. We compared the effectiveness of an injectable-containing regimen to that of an all-oral regimen among patients with drug-resistant tuberculosis who received bedaquiline- and/or delamanid as part of their multidrug regimen. METHODS Patients with a positive baseline culture were included. Six-month culture conversion was defined as two consecutive negative cultures collected >15 days apart. We derived predicted probabilities of culture conversion and relative risk using marginal standardisation methods. RESULTS Culture conversion was observed in 83.8% (526/628) of patients receiving an all-oral regimen and 85.5% (425/497) of those receiving an injectable-containing regimen. The adjusted relative risk comparing injectable-containing regimens to all-oral regimens was 0.96 (95%CI: 0.88-1.04). We found very weak evidence of effect modification by HIV status: among patients living with HIV, there was a small increase in the frequency of conversion among those receiving an injectable-containing regimen, relative to an all-oral regimen, which was not apparent in HIV-negative patients. CONCLUSIONS Among individuals receiving bedaquiline and/or delamanid as part of a multidrug regimen for drug-resistant tuberculosis, there was no significant difference between those who received an injectable and those who did not regarding culture conversion within 6 months. The potential contribution of injectable agents in the treatment of drug-resistant tuberculosis among those who were HIV positive requires further study.
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Affiliation(s)
- Palwasha Y Khan
- Interactive Research and Development Global, Singapore ; .,Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.,These authors contributed equally
| | - Molly F Franke
- Partners In Health, Boston, USA.,Department of Global Health and Social Medicine, Harvard Medical School.,These authors contributed equally
| | | | - Kwonjune J Seung
- Partners In Health, Boston, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA
| | - Helena Huerga
- Field Epidemiology Department, Epicentre, Paris, France
| | - Sidney Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA
| | - Saman Ahmed
- Interactive Research and Development, Karachi, Pakistan
| | - Munira Khan
- Interactive Research and Development, Durban, South Africa
| | - Tanha Sultana
- Interactive Research and Development, Dhaka, Bangladesh
| | | | - Luan N Q Vo
- Interactive Research and Development Global, Singapore.,Friends for International TB Relief, Ho Chi Minh City, Viet Nam
| | | | - Kalkidan Yae
- Partners In Health, Ethiopia, Addis Ababa, Ethiopia
| | | | | | | | - Stalz C Vilbrun
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | | | | | | | - Anita Mesic
- Médecins Sans Frontières, Amsterdam, Holland
| | - Nana Avagyan
- Medical Department, Médecins Sans Frontières, Paris, France
| | | | - Michael L Rich
- Partners In Health, Boston, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA
| | - Uzma Khan
- Interactive Research and Development Global, Singapore.,These authors contributed equally
| | - Carole D Mitnick
- Partners In Health, Boston, USA.,Department of Global Health and Social Medicine, Harvard Medical School.,These authors contributed equally
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13
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Hong H, Dowdy DW, Dooley KE, Francis HW, Budhathoki C, Han HR, Farley JE. Risk of hearing loss among multidrug-resistant tuberculosis patients according to cumulative aminoglycoside dose. Int J Tuberc Lung Dis 2021; 24:65-72. [PMID: 32005308 DOI: 10.5588/ijtld.19.0062] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: The ototoxic effects of aminoglycosides (AGs) lead to permanent hearing loss, which is one of the devastating consequences of multidrug-resistant tuberculosis (MDR-TB) treatment. As AG ototoxicity is dose-dependent, the impact of a surrogate measure of AG exposure on AG-induced hearing loss warrants close attention for settings with limited therapeutic drug monitoring.OBJECTIVE: To explore the prognostic impact of cumulative AG dose on AG ototoxicity in patients following initiation of AG-containing treatment for MDR-TB.DESIGN: This prospective cohort study was nested within an ongoing cluster-randomized trial of nurse case management intervention across 10 MDR-TB hospitals in South Africa.RESULTS: The adjusted hazard of AG regimen modification due to ototoxicity in the high-dose group (≥75 mg/kg/week) was 1.33 times higher than in the low-dose group (<75 mg/kg/week, 95%CI 1.09-1.64). The adjusted hazard of developing audiometric hearing loss was 1.34 times higher than in the low-dose group (95%CI 1.01-1.77). Pre-existing hearing loss (adjusted hazard ratio [aHR] 1.71, 95%CI 1.29-2.26) and age (aHR 1.16 per 10 years of age, 95%CI 1.01-1.33) were also associated with an increased risk of hearing loss.CONCLUSION: MDR-TB patients with high AG dose, advanced age and pre-existing hearing loss have a significantly higher risk of AG-induced hearing loss. Those at high risk may be candidates for more frequent monitoring or AG-sparing regimens.
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Affiliation(s)
- H Hong
- Johns Hopkins University School of Nursing, Baltimore, MD, The REACH Initiative, Johns Hopkins University School of Nursing, Baltimore, MD
| | - D W Dowdy
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - K E Dooley
- Divisions of Clinical Pharmacology and Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - H W Francis
- Division of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC
| | - C Budhathoki
- Johns Hopkins University School of Nursing, Baltimore, MD
| | - H-R Han
- Johns Hopkins University School of Nursing, Baltimore, MD, Center for Cardiovascular and Chronic Care, Johns Hopkins University, Baltimore, MD, USA
| | - J E Farley
- Johns Hopkins University School of Nursing, Baltimore, MD, The REACH Initiative, Johns Hopkins University School of Nursing, Baltimore, MD
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14
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Moodley S, Storbeck C, Gama N. Ototoxicity: A review of South African studies. S Afr Fam Pract (2004) 2021; 63:e1-e10. [PMID: 33764142 PMCID: PMC8377995 DOI: 10.4102/safp.v63i1.5187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 12/20/2020] [Accepted: 12/20/2020] [Indexed: 12/01/2022] Open
Abstract
Background Ototoxicity is damage to cells in the inner ear after administering a toxic drug, with a resultant hearing loss. Drugs used to treat illnesses such as cancer, tuberculosis, human immuno-deficiency virus (HIV) and infections are potentially ototoxic. South Africa has one of the highest rates of HIV and tuberculosis, and thus a potentially greater degree of the population is being affected by hearing loss from the medications used to treat these illnesses. Methods To determine the current status of research in ototoxicity, a systematic literature review was carried out to determine the focus areas of South African studies for the period 1989–2019. From the database search engines used (Science Direct, Ebscohost and Proquest), a total of 33 relevant articles were identified, including the themes of pharmacology, audiology and knowledge. Results Studies were conducted in the three most resourced provinces in South Africa. Findings indicate that there is a need for educating doctors regarding ototoxicity and a delineation of the role of the audiologist in monitoring and management of ototoxic hearing loss. There is a resultant need for audiology training on the pharmacology of ototoxic medication, otoprotective strategies and adherence to recommended guidelines. This has implications for university audiology training programmes and curriculum planning. The need for development of South Africa-specific audiology guidelines was highlighted. Conclusion Whilst it is noted that there is a lack of resources for effective implementation of ototoxicity-monitoring protocols, it is also noted that there are measures and otoprotective strategies that can be put in place without additional resources.
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Affiliation(s)
- Selvarani Moodley
- Centre for Deaf Studies, Faculty of Humanities, University of the Witwatersrand, Johannesburg.
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15
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Sabur NF, Brar MS, Wu L, Brode SK. Low-dose amikacin in the treatment of Multidrug-resistant Tuberculosis (MDR-TB). BMC Infect Dis 2021; 21:254. [PMID: 33691624 PMCID: PMC7945371 DOI: 10.1186/s12879-021-05947-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization recommends intravenous amikacin for the treatment of MDR-TB at a dose of 15 mg/kg. However, higher doses are associated with significant toxicity. METHODS Patients with MDR-TB treated at our institution receive amikacin at 8-10 mg/kg, with dose adjustment based on therapeutic drug monitoring. We conducted a retrospective cohort study of patients with MDR-TB who received amikacin between 2010 and 2016. RESULTS Forty-nine patients were included in the study. The median starting dose of amikacin was 8.9 mg/kg (IQR 8, 10), and target therapeutic drug levels were achieved at a median of 12 days (IQR 5, 26). The median duration of amikacin treatment was 7.2 months (IQR 5.7, 8), and median time to sputum culture conversion was 1 month (IQR 1,2). Six patients (12.2%) experienced hearing loss based on formal audiometry testing (95% CI 4.6-24.8%); 22.2% had subjective hearing loss (95% CI 11.2-37.1%) and 31.9% subjective tinnitus (95% CI 19.1-47.1%). Ten patients (23%) had a significant rise in serum creatinine (95% CI 11.8-38.6%), but only 5 patients had a GFR < 60 at treatment completion. 84% of patients had a successful treatment outcome (95% CI 84-99%). CONCLUSIONS Low dose amikacin is associated with relatively low rates of aminoglycoside-related adverse events. We hypothesize that low-dose amikacin can be used as a safe and effective treatment for MDR-TB in situations where an adequate regimen cannot be constructed with Group A and B drugs, and where careful monitoring for adverse events is feasible.
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Affiliation(s)
- Natasha F Sabur
- Department of Respirology, St. Michael's Hospital and West Park Healthcare Centre, Rm 6-049, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
| | - Mantaj S Brar
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Lisa Wu
- West Park Healthcare Centre, Toronto, Canada
| | - Sarah K Brode
- Department of Respirology, Toronto Western Hospital, West Park Healthcare Centre, and University of Toronto, Toronto, Canada
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16
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Lazarus G, Tjoa K, Iskandar AWB, Louisa M, Sagwa EL, Padayatchi N, Soetikno V. The effect of human immunodeficiency virus infection on adverse events during treatment of drug-resistant tuberculosis: A systematic review and meta-analysis. PLoS One 2021; 16:e0248017. [PMID: 33662024 PMCID: PMC7932087 DOI: 10.1371/journal.pone.0248017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/17/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Adverse events (AEs) during drug-resistant tuberculosis (DR-TB) treatment, especially with human immunodeficiency virus (HIV) co-infection, remains a major threat to poor DR-TB treatment adherence and outcomes. This meta-analysis aims to investigate the effect of HIV infection on the development of AEs during DR-TB treatment. METHODS Eligible studies evaluating the association between HIV seropositivity and risks of AE occurrence in DR-TB patients were included in this systematic review. Interventional and observational studies were assessed for risk of bias using the Risk of Bias in Nonrandomized Studies of Intervention and Newcastle-Ottawa Scale tool, respectively. Random-effects meta-analysis was performed to estimate the pooled risk ratio (RR) along with their 95% confidence intervals (CIs). RESULTS A total of 37 studies involving 8657 patients were included in this systematic review. We discovered that HIV infection independently increased the risk of developing AEs in DR-TB patients by 12% (RR 1.12 [95% CI: 1.02-1.22]; I2 = 0%, p = 0.75). In particular, the risks were more accentuated in the development of hearing loss (RR 1.44 [95% CI: 1.18-1.75]; I2 = 60%), nephrotoxicity (RR 2.45 [95% CI: 1.20-4.98], I2 = 0%), and depression (RR 3.53 [95% CI: 1.38-9.03]; I2 = 0%). Although our findings indicated that the augmented risk was primarily driven by antiretroviral drug usage rather than HIV-related immunosuppression, further studies investigating their independent effects are required to confirm our findings. CONCLUSION HIV co-infection independently increased the risk of developing AEs during DR-TB treatment. Increased pharmacovigilance through routine assessments of audiological, renal, and mental functions are strongly encouraged to enable prompt diagnosis and treatment in patients experiencing AEs during concomitant DR-TB and HIV treatment.
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Affiliation(s)
- Gilbert Lazarus
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Kevin Tjoa
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | - Melva Louisa
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Evans L. Sagwa
- Independent Pharmacoepidemiologist, Windhoek, Namibia and Nairobi, Kenya
| | - Nesri Padayatchi
- CAPRISA MRC-HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Vivian Soetikno
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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17
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Hong H, Dowdy DW, Dooley KE, Francis HW, Budhathoki C, Han HR, Farley JE. Aminoglycoside-induced Hearing Loss Among Patients Being Treated for Drug-resistant Tuberculosis in South Africa: A Prediction Model. Clin Infect Dis 2021; 70:917-924. [PMID: 30963176 DOI: 10.1093/cid/ciz289] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/04/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Individuals treated for drug-resistant tuberculosis (DR-TB) with aminoglycosides (AGs) in resource-limited settings often experience permanent hearing loss, yet there is no practical method to identify those at higher risk. We sought to develop a clinical prediction model of AG-induced hearing loss among patients initiating DR-TB treatment in South Africa. METHODS Using nested, prospective data from a cohort of 379 South African adults being treated for confirmed DR-TB with AG-based regimens we developed the prediction model using multiple logistic regression. Predictors were collected from clinical, audiological, and laboratory evaluations conducted at the initiation of DR-TB treatment. The outcome of AG-induced hearing loss was identified from audiometric and clinical evaluation by a worsened hearing threshold compared with baseline during the 6-month intensive phase. RESULTS Sixty-three percent of participants (n = 238) developed any level of hearing loss. The model predicting hearing loss at frequencies from 250 to 8000 Hz included weekly AG dose, human immunodeficiency virus status with CD4 count, age, serum albumin, body mass index, and pre-existing hearing loss. This model demonstrated reasonable discrimination (area under the receiver operating characteristic curve [AUC] = 0.71) and calibration (χ2[8] = 6.10, P = .636). Using a cutoff of 80% predicted probability of hearing loss, the positive predictive value of this model was 83% and negative predictive value was 40%. Model discrimination was similar for ultrahigh-frequency hearing loss (frequencies >9000 Hz; AUC = 0.81) but weaker for clinically determined hearing loss (AUC = 0.60). CONCLUSIONS This model may identify patients with DR-TB who are at highest risk of developing AG-induced ototoxicity and may help prioritize patients for AG-sparing regimens in clinical settings where access is limited.
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Affiliation(s)
- Hyejeong Hong
- Johns Hopkins University School of Nursing, Baltimore, Maryland.,The Research Education Advocacy Community Health Initiative, Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - David W Dowdy
- Departments of Epidemiology, and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kelly E Dooley
- Divisions of Clinical Pharmacology and Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Howard W Francis
- Division of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Hae-Ra Han
- Johns Hopkins University School of Nursing, Baltimore, Maryland.,Center for Cardiovascular and Chronic Care, Johns Hopkins University, Baltimore, Maryland
| | - Jason E Farley
- Johns Hopkins University School of Nursing, Baltimore, Maryland.,The Research Education Advocacy Community Health Initiative, Johns Hopkins University School of Nursing, Baltimore, Maryland
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18
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Seddon JA, Johnson S, Palmer M, van der Zalm MM, Lopez-Varela E, Hughes J, Schaaf HS. Multidrug-resistant tuberculosis in children and adolescents: current strategies for prevention and treatment. Expert Rev Respir Med 2020; 15:221-237. [PMID: 32965141 DOI: 10.1080/17476348.2021.1828069] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION An estimated 30,000 children develop multidrug-resistant (MDR) tuberculosis (TB) each year, with only a small proportion diagnosed and treated. This field has historically been neglected due to the perception that children with MDR-TB are challenging to diagnose and treat. Diagnostic and therapeutic developments in adults have improved pediatric management, yet further pediatric-specific research and wider implementation of evidence-based practices are required. AREAS COVERED This review combines the most recent data with expert opinion to highlight best practice in the evaluation, diagnosis, treatment, and support of children and adolescents with MDR-TB disease. A literature search of PubMed was carried out on topics related to MDR-TB in children. This review provides practical advice on MDR-TB prevention and gives updates on new regimens and novel treatments. The review also addresses host-directed therapy, comorbid conditions, special populations, psychosocial support, and post-TB morbidity, as well as identifying outstanding research questions. EXPERT OPINION Increased availability of molecular diagnostics has the potential to aid with the diagnosis of MDR-TB in children. Shorter MDR-TB disease treatment regimens have made therapy safer and shorter and further developments with novel agents and repurposed drugs should lead to additional improvements. The evidence base for MDR-TB preventive therapy is increasing.
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Affiliation(s)
- James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa.,Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Imperial College London , London, UK
| | - Sarah Johnson
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa.,Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Imperial College London , London, UK
| | - Megan Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - Marieke M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - Elisa Lopez-Varela
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa.,ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat De Barcelona , Barcelona, Spain
| | - Jennifer Hughes
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
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19
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Souleymane MB, Piubello A, Lawan IM, Hassane-Harouna S, Assao-Neino MM, Soumana A, Hamidou-Harouna Z, Gagara-Issoufou A, Ortuño-Gutiérrez N, Roggi A, Schwoebel V, Mamadou S, Lynen L, De Jong B, Van Deun A, Decroo T. High rifampicin-resistant TB cure rates and prevention of severe ototoxicity after replacing the injectable by linezolid in early stage of hearing loss. Eur Respir J 2020; 57:13993003.02250-2020. [PMID: 32703777 DOI: 10.1183/13993003.02250-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/13/2020] [Indexed: 11/05/2022]
Abstract
The short treatment regimen (STR) achieves a >80% cure in rifampicin-resistant tuberculosis (RR-TB) patients. However, ototoxicity induced by the injectable is a concern. This is the first study to evaluate the replacement of injectables by linezolid in patients with audiometry abnormalities at baseline or during the treatment.We conducted a retrospective cohort study of all RR-TB patients started on the STR between 2016 and June, 2019, in Niger. Patients underwent audiometry every 2 months in 2016 and every month since 2017.Of 195 patients, 16.9% (33 out of 195) received linezolid from the start (n=17), or switched from injectables to linezolid during treatment (n=16), based on audiometry abnormalities. In 2016, two patients developed severe ototoxicity despite switching to linezolid. Since 2017, no patient developed severe hearing loss or complete deafness. Severe haematological toxicity was observed in 18.1% (six out of 33) of patients on linezolid, none of which was life threatening. The use of linezolid was associated with severe but manageable adverse events (hazard ratio 8.9, 95% CI 2.5-31.5; p=0.001). A total of 90.9% (30 out of 33) of patients on a linezolid-containing STR were cured, and none experienced treatment failure. Three died, but not due to adverse events.Baseline and monthly audiometry monitoring and using linezolid after detection of hearing abnormalities appears effective to prevent severe ototoxicity, while keeping high treatment success and manageable adverse events.
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Affiliation(s)
| | - Alberto Piubello
- Damien Foundation, Niamey, Niger.,Damien Foundation, Brussels, Belgium
| | | | | | | | - Alphazazi Soumana
- National Reference Center against Tuberculosis and respiratory disease, Niamey, Niger
| | | | | | | | | | | | | | | | | | | | - Tom Decroo
- Institute of Tropical Medicine, Antwerp, Belgium.,Research Foundation Flanders, Brussels, Belgium
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20
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Hong H, Dowdy DW, Dooley KE, Francis HW, Budhathoki C, Han HR, Farley JE. Prevalence of Pre-Existing Hearing Loss Among Patients With Drug-Resistant Tuberculosis in South Africa. Am J Audiol 2020; 29:199-205. [PMID: 32320639 DOI: 10.1044/2020_aja-19-00103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose Hearing loss, resulting from aminoglycoside ototoxicity, is common among patients with drug-resistant tuberculosis (DR-TB). Those with pre-existing hearing loss are at particular risk of clinically important hearing loss with aminoglycoside-containing treatment than those with normal hearing at baseline. This study aimed to identify factors associated with pre-existing hearing loss among patients being treated for DR-TB in South Africa. Method Cross-sectional analysis nested within a cluster-randomized trial data across 10 South African TB hospitals. Patients ≥ 13 years old received clinical and audiological evaluations before DR-TB treatment initiation. Results Of 936 patients, average age was 35 years. One hundred forty-two (15%) reported pre-existing auditory symptoms. Of 482 patients tested by audiometry, 290 (60%) had pre-existing hearing loss. The prevalence of pre-existing hearing loss was highest among patients ≥ 50 years (adjusted prevalence ratio [aPrR] for symptoms 5.53, 95% confidence interval (CI) [3.63, 8.42]; aPrR for audiometric hearing loss 1.63, 95% CI [1.31, 2.03] compared to age 13-18 years) and among those with a prior history of second-line TB treatment (aPrR for symptoms 1.73, 95% CI [1.66, 1.80]; PrR for audiometric hearing loss 1.33, 95% CI [1.03, 1.73]). Having HIV with cluster of differentiation 4 cell count < 200 cells/mm3 and malnutrition were risk factors but did not reach statistical significance in adjusted analyses. Conclusion Pre-existing hearing loss is common among patients presenting for DR-TB treatment in South Africa, and those older than the age of 50 years or who had prior second-line TB treatment history were at highest risk.
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Affiliation(s)
- Hyejeong Hong
- The REACH Initiative, Johns Hopkins University School of Nursing, Baltimore, MD
- Johns Hopkins University School of Nursing, Baltimore, MD
| | - David W. Dowdy
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kelly E. Dooley
- Divisions of Clinical Pharmacology and Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Howard W. Francis
- Division of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC
| | - Chakra Budhathoki
- The REACH Initiative, Johns Hopkins University School of Nursing, Baltimore, MD
| | - Hae-Ra Han
- The REACH Initiative, Johns Hopkins University School of Nursing, Baltimore, MD
- Center for Cardiovascular and Chronic Care, The Johns Hopkins University, Baltimore, MD
| | - Jason E. Farley
- The REACH Initiative, Johns Hopkins University School of Nursing, Baltimore, MD
- Johns Hopkins University School of Nursing, Baltimore, MD
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Meintjes G, Brust JCM, Nuttall J, Maartens G. Management of active tuberculosis in adults with HIV. Lancet HIV 2020; 6:e463-e474. [PMID: 31272663 DOI: 10.1016/s2352-3018(19)30154-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/25/2019] [Accepted: 05/08/2019] [Indexed: 12/11/2022]
Abstract
Every year, about 1 million people living with HIV worldwide develop tuberculosis. Although the drug regimens used to treat tuberculosis in these patients are the same as those used in HIV-negative patients, cotreatment of tuberculosis with antiretroviral therapy involves challenges including the optimal timing of antiretroviral initiation, drug-drug interactions, drug tolerability, and the prevention and treatment of tuberculosis-associated immune reconstitution syndrome. Furthermore, mortality is high in people with HIV who are diagnosed with tuberculosis during a hospital admission, and in those with tuberculous meningitis. Studies in this field have better characterised these challenges and informed optimal management and guideline revisions. In patients with tuberculosis, antiretroviral therapy improves survival, is well tolerated, and can be adjusted to manage drug-drug interactions with rifampicin. Prednisone is effective in both preventing and treating the paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome.
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Affiliation(s)
- Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, South Africa; Division of Infectious Diseases and HIV Medicine, Department of Medicine, South Africa.
| | - James C M Brust
- University of Cape Town, Observatory, South Africa; Divisions of General Internal Medicine and Infectious Diseases, Albert Einstein College of Medicine, New York, NY, USA
| | - James Nuttall
- Department of Paediatrics and Child Health, South Africa
| | - Gary Maartens
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, South Africa; Division of Clinical Pharmacology, Department of Medicine, South Africa
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22
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Ejigu DA, Abay SM. N-Acetyl Cysteine as an Adjunct in the Treatment of Tuberculosis. Tuberc Res Treat 2020; 2020:5907839. [PMID: 32411461 PMCID: PMC7210531 DOI: 10.1155/2020/5907839] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/04/2020] [Accepted: 04/22/2020] [Indexed: 01/19/2023] Open
Abstract
Oxidative stress is a common feature of tuberculosis (TB), and persons with reduced antioxidants are at more risk of TB. TB patients with relatively severe oxidative stress had also more advanced disease as measured by the Karnofsky performance index. Since adverse effects from anti-TB drugs are also mediated by free radicals, TB patients are prone to side effects, such as hearing loss. In previous articles, researchers appealed for clinical trials aiming at evaluating N-acetyl cysteine (NAC) in attenuating the dreaded hearing loss during multidrug-resistant TB (MDR-TB) treatment. However, before embarking on such trials, considerations of NAC's overall impact on TB treatment are crucial. Unfortunately, such a comprehensive report on NAC is missing in the literature and this manuscript reviews the broader effect of NAC on TB treatment. This paper discusses NAC's effect on mycobacterial clearance, hearing loss, drug-induced liver injury, and its interaction with anti-TB drugs. Based on the evidence accrued to date, NAC appears to have various beneficial effects on TB treatment. However, despite the favorable interaction between NAC and first-line anti-TB drugs, the interaction between the antioxidant and some of the second-line anti-TB drugs needs further investigations.
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Affiliation(s)
- Dawit A. Ejigu
- Department of Pharmacology, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Solomon M. Abay
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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23
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Trébucq A, Decroo T, Van Deun A, Piubello A, Chiang CY, Koura KG, Schwoebel V. Short-Course Regimen for Multidrug-Resistant Tuberculosis: A Decade of Evidence. J Clin Med 2019; 9:E55. [PMID: 31881691 PMCID: PMC7019808 DOI: 10.3390/jcm9010055] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 02/06/2023] Open
Abstract
About ten years ago, the first results of the so-called "Bangladesh regimen", a short regimen lasting nine months instead of 20 months, revolutionized multidrug-resistant tuberculosis (MDR-TB) treatment. Similar short regimens were studied in different settings, relying for their efficacy on a later generation fluoroquinolone, either gatifloxacin, moxifloxacin, or levofloxacin. We review the published material on short MDR-TB regimens, describe their different compositions, their results in national tuberculosis programs in middle- and low-income countries, the risk of acquiring resistance to fluoroquinolone, and the occurrence of adverse events. With over 80% success, the regimen performs much better than longer regimens (usually around 50%). Monitoring of adverse events allows adapting its composition to prevent severe adverse events such as deafness. We discuss the current applicability and usefulness of the short injectable-containing regimen given the 2019 recommendation of the World Health Organization (WHO) for a new long all-oral regimen. We conclude that the most effective fluoroquinolone is gatifloxacin, currently not listed as an essential medicine by WHO. It is a priority to restore its status as an essential medicine.
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Affiliation(s)
- Arnaud Trébucq
- International Union Against Tuberculosis and Lung Disease, 75006 Paris, France; (A.P.); (C.-Y.C.); (K.G.K.); (V.S.)
| | - Tom Decroo
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium;
- Research Foundation Flanders, 1000 Brussels, Belgium
| | - Armand Van Deun
- Mycobacteriology Unit, Institute of Tropical Medicine, 2000 Antwerp, Belgium;
| | - Alberto Piubello
- International Union Against Tuberculosis and Lung Disease, 75006 Paris, France; (A.P.); (C.-Y.C.); (K.G.K.); (V.S.)
- Damien Foundation, POBox 1065, Niamey, Niger
| | - Chen-Yuan Chiang
- International Union Against Tuberculosis and Lung Disease, 75006 Paris, France; (A.P.); (C.-Y.C.); (K.G.K.); (V.S.)
- Division of Pulmonary Medicine, Department of Internal Medicine, Wanfang Hospital, Taipei Medical University, Taipei 11696, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Kobto G. Koura
- International Union Against Tuberculosis and Lung Disease, 75006 Paris, France; (A.P.); (C.-Y.C.); (K.G.K.); (V.S.)
- COMUE Sorbonne Paris Cité, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, 75006 Paris, France
- École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Epidémiologique, Université de Parakou, Parakou, Benin
| | - Valérie Schwoebel
- International Union Against Tuberculosis and Lung Disease, 75006 Paris, France; (A.P.); (C.-Y.C.); (K.G.K.); (V.S.)
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24
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Shibeshi W, Sheth AN, Admasu A, Berha AB, Negash Z, Yimer G. Nephrotoxicity and ototoxic symptoms of injectable second-line anti-tubercular drugs among patients treated for MDR-TB in Ethiopia: a retrospective cohort study. BMC Pharmacol Toxicol 2019; 20:31. [PMID: 31122273 PMCID: PMC6533713 DOI: 10.1186/s40360-019-0313-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/15/2019] [Indexed: 01/09/2023] Open
Abstract
Background Nephrotoxicity and ototoxicity are clinically significant dose-related adverse effects associated with second-line anti-tubercular injectables drugs (aminoglycosides and capreomycin) used during intensive phase of treatment of multi-drug resistant tuberculosis (MDR-TB) patients. Data are scarce on injectable-induced nephrotoxicity and ototoxicity in Ethiopian MDR-TB patients. The aim of this study was to assess the prevalence, management of nephrotoxicity and ototoxic symptoms and treatment outcomes of patients treated for MDR-TB with injectable-based regimens. Method This was retrospective cohort study based on review of medical records of about 900 patients on MDR-TB treatment from January 2010 to December 2015 at two large TB referral hospitals in Addis Ababa, Ethiopia. Nephrotoxicity in study participants was screened using baseline and monthly measurement of serum creatinine and clinical diagnosis and patient reports. Results Overall, 473 (54.2%) of participants were male. Children accounted for 47 (5.5%) of cases and the mean age of participants was 32 ± 12.6 years with range of 2–75 years. The majority (n = 788, 84.6%) of participants had past history of TB. The most commonly used injectable anti-TB drug was capreomycin (n = 789, 84.7%), while kanamycin and amikacin were also used. There was a statistically significant increment (p<0.05) in the mean serum creatinine values from baseline throughout intensive phase of treatment with a 10–18% prevalence of nephrotoxicity. Based on clinical criteria, nephrotoxicity was detected in 62 (6.7%) and ototoxic symptoms were detected in 42 (4.8%) participants. Nephrotoxicity and ototoxic symptoms were clinically managed by modification of treatment regimens including dose and frequency of drug administration. Conclusion Nephrotoxicity and ototoxic symptoms were significant problems among patients on follow-up for MDR-TB treatment. Based on laboratory criteria (serum creatinine), nephrotoxicity remained significant adverse events throughout intensive phase of treatment, indicating close monitoring of patients for successful outcome is mandatory until countries adopt the recent injectable-free WHO guideline and under specific conditions.
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Affiliation(s)
- Workineh Shibeshi
- Department of Pharmacology & Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Addisu Admasu
- St.Peter's Specialized Hospital, Addis Ababa, Ethiopia
| | - Alemseged Beyene Berha
- Department of Pharmacology & Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zenebe Negash
- Department of Pharmacology & Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getnet Yimer
- Department of Pharmacology & Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Global One Health initiative, Eastern Africa Regional Office, Office of International Affairs, The Ohio State University, Addis Ababa, Ethiopia
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25
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Hong H, Dooley KE, Starbird LE, Francis HW, Farley JE. Adverse outcome pathway for aminoglycoside ototoxicity in drug-resistant tuberculosis treatment. Arch Toxicol 2019; 93:1385-1399. [PMID: 30963202 DOI: 10.1007/s00204-019-02407-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/06/2019] [Indexed: 12/22/2022]
Abstract
Individuals treated for multidrug-resistant tuberculosis (MDR-TB) with aminoglycosides (AGs) in resource-limited settings often experience permanent hearing loss. However, AG ototoxicity has never been conceptually integrated or causally linked to MDR-TB patients' pre-treatment health condition. We sought to develop a framework that examines the relationships between pre-treatment conditions and AG-induced hearing loss among MDR-TB-infected individuals in sub-Saharan Africa. The adverse outcome pathway (AOP) approach was used to develop a framework linking key events (KEs) within a biological pathway that results in adverse outcomes (AO), which are associated with chemical perturbation of a molecular initiating event (MIE). This AOP describes pathways initiating from AG accumulation in hair cells, sound transducers of the inner ear immediately after AG administration. After administration, the drug catalyzes cellular oxidative stress due to overproduction of reactive oxygen species. Since oxidative stress inhibits mitochondrial protein synthesis, hair cells undergo apoptotic cell death, resulting in irreversible hearing loss (AO). We identified the following pre-treatment conditions that worsen the causal linkage between MIE and AO: HIV, malnutrition, aging, noise, smoking, and alcohol use. The KEs are: (1) nephrotoxicity, pre-existing hearing loss, and hypoalbuminemia that catalyzes AG accumulation; (2) immunodeficiency and antioxidant deficiency that trigger oxidative stress pathways; and (3) co-administration of mitochondrial toxic drugs that hinder mitochondrial protein synthesis, causing apoptosis. This AOP clearly warrants the development of personalized interventions for patients undergoing MDR-TB treatment. Such interventions (i.e., choosing less ototoxic drugs, scheduling frequent monitoring, modifying nutritional status, avoiding poly-pharmacy) will be required to limit the burden of AG ototoxicity.
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Affiliation(s)
- Hyejeong Hong
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, USA. .,Johns Hopkins University School of Nursing, The REACH Initiative, 855 N. Wolfe Street, 21205, Baltimore, MD, USA.
| | - Kelly E Dooley
- Divisions of Clinical Pharmacology and Infectious Disease, Johns Hopkins University School of Medicine, 600 North Wolfe Street, 21205, Baltimore, MD, USA
| | - Laura E Starbird
- Center for Health Policy, Columbia University School of Nursing, 560 W 168 St, 10032, New York, NY, USA
| | - Howard W Francis
- Division of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, 40 Duke Medicine Circle, 27710, Durham, NC, USA
| | - Jason E Farley
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, USA.,Johns Hopkins University School of Nursing, The REACH Initiative, 855 N. Wolfe Street, 21205, Baltimore, MD, USA
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