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Meta-Analysis
. 2015 Mar;95(2):112-22.
doi: 10.1016/j.tube.2014.10.006. Epub 2014 Dec 18.

Hepatotoxicity from antituberculous therapy in the elderly: a systematic review

Jennifer D Hosford  1 , Michael E von Fricken  2 , Michael Lauzardo  1 , Myron Chang  3 , Yunfeng Dai  3 , Jennifer A Lyon  4 , John Shuster  5 , Kevin P Fennelly  6
Affiliations
Meta-Analysis

Hepatotoxicity from antituberculous therapy in the elderly: a systematic review

Jennifer D Hosford et al. Tuberculosis (Edinb). 2015 Mar.

Abstract

Background: 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).

Methods: A systematic review of MEDLINE, Cochrane Controlled Trial Registry, CINAHL(®), 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.

Findings: Thirty-eight studies (40,034 participants; 1208 cases of hepatotoxicity) met the selection criteria. For active TB, an overall mean effect of 0.277 (p = 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 (p < 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).

Interpretation: 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.

Keywords: Aging; Antituberculous; Elderly; Hepatotoxicity; Latent tuberculosis; Systematic review; Therapy; Toxicity; Treatment; Tuberculosis.

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Conflict of interest statement

Conflicts of interest: The authors have no conflicts of interest with the findings from this study.

Figures

Figure 1
Figure 1
Study selection process for systematic review of studies comparing age-related rates of hepatotoxicity in treatment for tuberculosis infection.
Figure 2
Figure 2
Log Odds Ratios and Associated 95% Confidence Intervals of studies included in a Meta-Analysis assessing age-related risk of hepatotoxicity in those with Active Tuberculosis.
Figure 3
Figure 3
Log Odds Ratios and Associated 95% Confidence Intervals of studies included in a Meta-Analysis assessing age-related risk of hepatotoxicity in those with LTBI Tuberculosis.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention (CDC) Reported tuberculosis in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services; 2012.
    1. Devarbhavi H. Antituberculous drug-induced liver injury: current perspective. Trop Gastroenterol. 2011;32(3):167–74. - PubMed
    1. Saukkonen JJ. An official ATS statement: hepatotoxicity of antituberculosis therapy. Am J Respir Crit Care Med. 2006;174(8):935. - PubMed
    1. Blumberg HM. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med. 2003;167(4):603–62. - PubMed
    1. Griffith DE. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007;175(4):367. - PubMed

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