Drug-related hepatitis in patients treated with standard anti-tuberculosis chemotherapy over a 30-year period

• Published in: The international journal of tuberculosis and lung disease Vol. 20; no. 12; pp. 1621 - 1624
• Main Authors: Bright-Thomas, R. J., Gondker, A. R., Morris, J., Ormerod, L. P.
• Format: Journal Article
• Language: English
• Published: France International Union Against Tuberculosis and Lung Disease 01-12-2016
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Antitubercular Agents - administration & dosage; Antitubercular Agents - adverse effects; Chemical and Drug Induced Liver Injury - diagnosis; Chemical and Drug Induced Liver Injury - epidemiology; Child; Child, Preschool; Drug Side Effects; Ethambutol - therapeutic use; Female; Follow-Up Studies; Hepatitis - diagnosis; Hepatitis - epidemiology; Humans; Incidence; Infant; Infant, Newborn; Isoniazid - therapeutic use; Longitudinal Studies; Male; Middle Aged; Prospective Studies; Pyrazinamide - therapeutic use; Rifampin - therapeutic use; Tuberculosis; Tuberculosis - drug therapy; Young Adult
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.16.0370

SETTING: Drug-induced hepatitis is known to occur in a proportion of patients on treatment for active tuberculosis (TB).DESIGN: We prospectively examined the incidence of drug-induced hepatitis in 2070 patients treated for TB with the standard regimen based on 6 months of rifampicin
(R, RMP) and isoniazid (H, INH), with 2 months of initial pyrazinamide (Z, PZA) and ethambutol (E, EMB), over a 30-year period from 1981 to 2010, in Blackburn, UK.RESULTS: Of the 1031 (49.8%) males and 1039 (50.2%) females studied, 451 (21.8%) were White and 1585 (76.6%) were of South
Asian origin. Only 34 (1.6%) were of African or other origins. Of the total number of patients treated, 63 (3.0%) had drug-related hepatitis, 26 (5.8%) of whom were White, 37 (2.33%) Asians and 0 other. Incidence was significantly higher in Whites than Asians (OR 2.13, P = 0.008). Incidence
increased with increasing age (OR 1.16, P = 0.02). The presumed causative drug was PZA 57%, RMP 32%, INH 11%, EMB 0%. There was no trend of increased hepatitis rates over time.CONCLUSION: Rates of drug-induced hepatitis where change of treatment is required are low in patients treated
with standard RHZE-based therapy (3%). Caucasians and older patients were more likely to develop hepatitis than their counterparts.