Hepatotoxicity from antituberculous therapy in the elderly: A systematic review. Issue 2 (March 2015)

• Record Type: Journal Article
• Authors: Hosford, Jennifer D.; von Fricken, Michael E.; Lauzardo, Michael; Chang, Myron; Dai, Yunfeng; Lyon, Jennifer A.; Shuster, John; Fennelly, Kevin P.
• Is Part Of: Tuberculosis. Volume 95:Issue 2(2015)
• Page Start: 112
• Page End: 122
• Publication Date: 2015-03
• Subjects: 616.995
• DOI: 10.1016/j.tube.2014.10.006
• Languages: English
• ISSNs: 1472-9792

Abstract

<abstract xml:lang="en" abstract-type="author" id="abs0010"> <title id="sectitle0010">Summary</title> <sec> <title id="sectitle0015">Background</title> <p id="abspara0010">Elderly persons have the highest rates of tuberculosis (TB) in the United States compared to all other age groups. A systematic literature review was conducted to determine if older age was a risk factor for hepatotoxicity resulting from treatment with first-line drugs used to treat active (TB) and latent tuberculosis (LTBI).</p> </sec> <sec> <title id="sectitle0020">Methods</title> <p id="abspara0015">A systematic review of MEDLINE, Cochrane Controlled Trial Registry, CINAHL<sup>®</sup>, and Science Citation Index Expanded (from 1970 to 2011) was performed to determine the risk of hepatotoxicity, comparing those over 60 with those under 60. A meta-analysis was performed using a random effects model along with log odds ratios and the chi-square test.</p> </sec> <sec> <title id="sectitle0025">Findings</title> <p id="abspara0020">Thirty-eight studies (40, 034 participants; 1208 cases of hepatotoxicity) met the selection criteria. For active TB, an overall mean effect of 0.277 (<italic>p</italic> = 0.024, 95% CI: 0.037–0.517) was observed, which is equivalent to an odds ratio of 1.32 (95% CI: 1.04–1.68). For LTBI, an overall mean effect of 1.42 (<italic>p</italic> < 0.001, 95% CI: 0.794–2.05) was observed, which translates to an odds ratio of 4.14 (95% CI: 2.21–7.74).</p> </sec> <sec> <title id="sectitle0030">Interpretation</title> <p id="abspara0025">Our analysis revealed that patients older than 60 had significantly more risk of hepatotoxicity. These studies suggest that a gentler regimen of treatment for older individuals could benefit health outcomes in this population of TB patients and minimize risks to the public's health.</p> </sec> </abstract>