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Cheng LT, Chung CH, Peng CK, Shu CC, Wu SY, Wang SH, Wu GJ, Tsao CH, Sun CA, Chien WC, Tang SE. Bidirectional Relationship Between Tuberculosis and Hypothyroidism: An 18-Year Nationwide Population-Based Longitudinal Cohort Study. Front Med (Lausanne) 2022; 9:900858. [PMID: 35903317 PMCID: PMC9320323 DOI: 10.3389/fmed.2022.900858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Some antituberculosis agents may cause hypothyroidism, and thyroid hormones play a vital role in Mycobacterium tuberculosis infection. However, the relationship between tuberculosis (TB) and hypothyroidism has not been clearly established. Therefore, this retrospective, longitudinal cohort study aimed to investigate the association between these two diseases using the 2000–2017 data from the Taiwan's National Health Insurance Research Database. The hypothyroidism and TB cohorts were matched with the control group in a 1:4 ratio. Adjusted hazard ratios (aHRs) were assessed using Cox proportional hazards regression analysis in each cohort. In total, 3,976 individuals with hypothyroidism and 35 120 individuals with TB were included in this study. The risk of developing TB in patients with hypothyroidism was 2.91 times higher than that in those without hypothyroidism (95% confidence interval [CI], 1.50–3.65). The subgroup of thyroxine replacement therapy (TRT) had a 2.40 times higher risk (95% CI, 1.26–3.01), whereas the subgroup of non-TRT had a 3.62 times higher risk of developing TB than those without hypothyroidism (95% CI, 2.19–4.84). On the other hand, the risk of developing hypothyroidism in patients with TB was 2.01 times higher than that in those without TB (95% CI, 1.41–2.38). Our findings provide evidence that TB and hypothyroidism are interrelated. Thus, clinicians and public health authorities should monitor the association between these two diseases to reduce the relevant disease burden.
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Affiliation(s)
- Li-Ting Cheng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
- National Defense Medical Center, School of Public Health, Taipei, Taiwan
| | - Chung-Kan Peng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Chin-Chung Shu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Yu Wu
- National Defense Medical Center, Graduate Institute of Aerospace and Undersea Medicine, Taipei, Taiwan
| | - Sheng-Huei Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Gwo-Jang Wu
- Department of Medical Research, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
- National Defense Medical Center, Graduate Institute of Medical Sciences, Taipei, Taiwan
- Department of Obstetrics and Gynecology, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Chang-Huei Tsao
- Department of Medical Research, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
- Department of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- National Defense Medical Center, Graduate Institute of Life Sciences, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
- National Defense Medical Center, School of Public Health, Taipei, Taiwan
- National Defense Medical Center, Graduate Institute of Life Sciences, Taipei, Taiwan
- *Correspondence: Wu-Chien Chien
| | - Shih-En Tang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
- National Defense Medical Center, Graduate Institute of Aerospace and Undersea Medicine, Taipei, Taiwan
- Shih-En Tang
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Host bioenergetic parameters reveal cytotoxicity of anti-tuberculosis drugs undetected using conventional viability assays. Antimicrob Agents Chemother 2021; 65:e0093221. [PMID: 34339269 PMCID: PMC8448146 DOI: 10.1128/aac.00932-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
High attrition rates in tuberculosis (TB) drug development have been largely attributed to safety, which is likely due to the use of endpoint assays measuring cell viability to detect drug cytotoxicity. In drug development for cancer, metabolic, and neurological disorders and for antibiotics, cytotoxicity is increasingly being assessed using extracellular flux (XF) analysis, which measures cellular bioenergetic metabolism in real time. Here, we adopt the XF platform to investigate the cytotoxicity of drugs currently used in TB treatment on the bioenergetic metabolism of HepG2 cells, THP-1 macrophages, and human monocyte-derived macrophages (hMDMs). We found that the XF analysis reveals earlier drug-induced effects on the cells’ bioenergetic metabolism prior to cell death, measured by conventional viability assays. Furthermore, each cell type has a distinct response to drug treatment, suggesting that more than one cell type should be considered to examine cytotoxicity in TB drug development. Interestingly, chemically unrelated drugs with different modes of action on Mycobacterium tuberculosis have similar effects on the bioenergetic parameters of the cells, thus discouraging the prediction of potential cytotoxicity based on chemical structure and mode of action of new chemical entities. The clustering of the drug-induced effects on the hMDM bioenergetic parameters are reflected in the clustering of the effects of the drugs on cytokine production in hMDMs, demonstrating concurrence between the effects of the drugs on the metabolism and functioning of the macrophages. These findings can be used as a benchmark to establish XF analysis as a new tool to assay cytotoxicity in TB drug development.
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Biranu E, Wolde M, Edao Negesso A, Hailu Tola H, Molla Sisay M. Thyroid Profile and Factors Associated with Hypothyroidism Among Multidrug-Resistant Tuberculosis Patients Attending Saint Peter's Specialized Hospital Addis Ababa, Ethiopia. Infect Drug Resist 2021; 14:2675-2684. [PMID: 34285520 PMCID: PMC8285920 DOI: 10.2147/idr.s310404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background The emergence of MDR-TB is a global public health problem. Hypothyroidism is one of the severe adverse drug reactions (ADRs) in MDR-TB patients on treatment. Representative data on hypothyroidism and its associated factors among MDR-TB patients are lacking. Objective To determine thyroid profiles and associated risk factors among multidrug-resistant TB patients during therapy with anti-MDR-TB regimen in Saint Peter Specialized Hospital Addis Ababa, Ethiopia from January to November 2020. Methods A cross-sectional study was conducted in MDR-TB patients in Addis Ababa, Ethiopia. A total of 162 patients, who were older than 18 years, had bacteriologically confirmed MDR-TB and on treatment for more than one month were enrolled consecutively from the TB registration book. However, critically sick patients and those who were receiving additional drugs known to cause severe ADRs were excluded. Simple descriptive statistics were used to present the socio-demographic and clinical characteristics of the patients. A logistic regression model was used to assess the association between independent and dependent variables. A p-value <0.05 was considered as statistically significant in all analyses. Results Mean age of the study participant was 35.9 ± 13.6 years. The prevalence of hypothyroidism was 32 (19.8%). The presence of co-morbidity, being underweight, and prothionamide use were significantly associated with hypothyroidism in MDR-TB patients on treatment. Conclusion Hypothyroidism occurs commonly among MDR-TB patients. Presence of co-morbidity, being underweight, and prothionamide drug use are the factors associated with hypothyroidism. Monitoring of thyroid function test during MDR-TB treatment and factors associated with hypothyroidism require attention to prevent complication.
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Affiliation(s)
- Endalkchew Biranu
- Addis Ababa University College of Health Sciences Department of Medical Laboratory Sciences, Addis Ababa, Ethiopia.,St. Peter's Specialized Hospital, Research and Evidence Generation Directorate, Addis Ababa, Ethiopia
| | - Mistire Wolde
- Addis Ababa University College of Health Sciences Department of Medical Laboratory Sciences, Addis Ababa, Ethiopia
| | - Abebe Edao Negesso
- Addis Ababa University College of Health Sciences Department of Medical Laboratory Sciences, Addis Ababa, Ethiopia
| | - Habteyes Hailu Tola
- Ethiopian Public Health Institute, Tuberculosis/HIV Research Directorate, Addis Ababa, Ethiopia
| | - Million Molla Sisay
- St. Peter's Specialized Hospital, Research and Evidence Generation Directorate, Addis Ababa, Ethiopia
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Benvenga S. L-T4 Therapy in the Presence of Pharmacological Interferents. Front Endocrinol (Lausanne) 2020; 11:607446. [PMID: 33414765 PMCID: PMC7783463 DOI: 10.3389/fendo.2020.607446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/17/2020] [Indexed: 01/11/2023] Open
Abstract
Pharmacological interference on L-thyroxine (L-T4) therapy can be exerted at several levels, namely from the hypothalamus/pituitary through the intestine, where the absorption of exogenous L-T4 takes place. A number of medications interfere with L-T4 therapy, some of them also being the cause of hypothyroidism. The clinician should be aware that some medications simply affect thyroid function tests with no need of modifying the dose of L-T4 that the patient was taking prior to their prescription. Usually, the topic of pharmacological interference on L-T4 therapy addresses the patient with primary hypothyroidism, in whom periodic measurement of serum thyrotropin (TSH) is the biochemical target. However, this minireview also addresses the patient with central hypothyroidism, in whom the biochemical target is serum free thyroxine (FT4). This minireview also addresses two additional topics. One is the costs associated with frequent monitoring of the biochemical target when L-T4 is taken simultaneously with the interfering drug. The second topic is the issue of metabolic/cardiovascular complications associated with undertreated hypothyroidism.
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Affiliation(s)
- Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Master Program on Childhood, Adolescent and Women’s Endocrine Health, University of Messina, Messina, Italy
- Interdepartmental Program of Molecular & Clinical Endocrinology and Women’s Endocrine Health, University Hospital, A.O.U. Policlinico G. Martino, Messina, Italy
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Cheung YMM, Van K, Lan L, Barmanray R, Qian SY, Shi WY, Wong JLA, Hamblin PS, Colman PG, Topliss DJ, Denholm JT, Grossmann M. Hypothyroidism associated with therapy for multi-drug-resistant tuberculosis in Australia. Intern Med J 2019; 49:364-372. [PMID: 30151969 DOI: 10.1111/imj.14085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/25/2018] [Accepted: 08/20/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Reports from resource-poor countries have associated thionamide- and para-aminosalicylate sodium (PAS)-based treatment of multi-drug-resistant tuberculosis (MDR-TB) with the development of hypothyroidism. AIM To identify predictors and assess the cumulative proportions of hypothyroidism in patients treated for MDR-TB with these agents in Australia. METHODS Retrospective multicentre study of MDR-TB patients from five academic centres covering tuberculosis (TB) services in Victoria, Australia. Patients were identified using each centre's pharmacy department and cross checked with the Victorian Tuberculosis Program. Hypothyroidism was categorised as subclinical if the thyroid-stimulating hormone was elevated and as overt if free thyroxine (fT4) was additionally reduced on two separate occasions. Our main outcome measured was the cumulative proportion of hypothyroidism (at 5 years from treatment initiation). RESULTS Of the 29 cases available for analysis, the cumulative proportion of hypothyroidism at 5 years was 37% (95% confidence interval (CI): 0-57.8%). Eight of the nine affected cases developed hypothyroidism within the first 12 months of treatment. Hypothyroidism was marginally (P = 0.06) associated with higher prothionamide/PAS dosing and was reversible with cessation of the anti-tuberculosis medication. CONCLUSIONS Prothionamide/PAS treatment-associated hypothyroidism is common in MDR-TB patients in Australia, emphasising the importance of regular thyroid function monitoring during this treatment. Thyroid hormone replacement, if initiated, may not need to be continued after MDR-TB treatment is completed.
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Affiliation(s)
- Yee-Ming M Cheung
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
| | - Karen Van
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia
| | - Lan Lan
- Department of Endocrinology and Diabetes, Western Health, Melbourne, Victoria, Australia
| | - Rahul Barmanray
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Sarah Y Qian
- Department of Endocrinology and Diabetes, The Alfred Hospital, Melbourne, Victoria, Australia
| | - William Y Shi
- Melbourne Medical School, The University of Melbourne, Victoria, Australia
| | - Jennifer L A Wong
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia.,Diabetes and Vascular Medicine Research Program, Monash Centre for Health Research and Implementation, School of Public Health, Monash University, Melbourne, Victoria, Australia
| | - Peter S Hamblin
- Department of Endocrinology and Diabetes, Western Health, Melbourne, Victoria, Australia.,Department of Medicine-Western Precinct, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter G Colman
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Duncan J Topliss
- Department of Endocrinology and Diabetes, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Justin T Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, Victoria, Australia.,Department of Microbiology and Immunology, The University of Melbourne, Peter Doherty Institute for Infection and Immunity, Victoria, Australia
| | - Mathis Grossmann
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Victoria, Australia
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6
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Treatment of Multi-drug Resistant Tuberculosis Causing Tubulopathy — Gitelman-like Syndrome. Indian Pediatr 2019. [DOI: 10.1007/s13312-019-1662-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tola HH, Holakouie-Naieni K, Lejisa T, Mansournia MA, Yaseri M, Tesfaye E, Mola M. Is hypothyroidism rare in multidrug resistance tuberculosis patients on treatment? A systematic review and meta-analysis. PLoS One 2019; 14:e0218487. [PMID: 31211809 PMCID: PMC6581430 DOI: 10.1371/journal.pone.0218487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 06/03/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Hypothyroidism is one of the adverse drug reactions that associated with Multidrug Resistant Tuberculosis (MDR-TB) medications. Extremely variable magnitude of hypothyroidism in MDR-TB patients has been reported from different parts of the world. However, there is no evidence that tried to estimate the pooled prevalence of hypothyroidism to confirm the rareness of hypothyroidism in MDR-TB patients on treatment. Therefore, we did a systematic review and meta-analysis to estimate the prevalence of hypothyroidism in MDR-TB patients on treatment, and to summarize the demographic and clinical characteristics of the patients. METHODS We conducted a systematic review and meta-analysis on studies reported around the world on the prevalence of hypothyroidism in MDR-TB patients on treatment. We searched electronic databases: PubMed/Medline, EMBASE, CINAHL, Science Direct, Academic Search Complete and Google scholar for English language articles without limiting publication year. We also reviewed the bibliographies of relevant studies and conducted an electronic search for relevant conference abstracts. Eligible studies were cross-sectional and cohort studies that included at least five participants. We used a random-effects model to estimate the pooled prevalence of hypothyroidism. The registration number of this review study protocol is CRD42018109237. RESULTS We included 30 studies and pooled data on a total of 6,241 MDR-TB patients. The crude prevalence of hypothyroidism was extremely heterogeneous. The pooled prevalence of hypothyroidism in MDR-TB patients on treatment was 17.0% (95% CI: 13.0-20.0). Ethionamide and para-aminosalicylic acid (PAS) were the most frequently reported drugs that associated with the occurrence of hypothyroidism. CONCLUSION This review revealed that hypothyroidism is not a rare adverse drug reaction in MDR-TB patients on treatment. Ethionamide and PAS were the most frequently reported drugs that associated with the occurrence of hypothyroidism. Screening of hypothyroidism in MDR-TB patients on treatment is important while targeting patients on Ethionamide and PAS based treatment regimen.
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Affiliation(s)
- Habteyes Hailu Tola
- Tehran University of Medical Sciences-International Campus, School of Public Health, Department of Epidemiology and Biostatistics, Tehran, Iran
- Ethiopian Public Health Institute, Tuberculosis/HIV Research Directorate, Addis Ababa, Ethiopia
| | - Kourosh Holakouie-Naieni
- Tehran University of Medical Sciences-International Campus, School of Public Health, Department of Epidemiology and Biostatistics, Tehran, Iran
| | - Tadesse Lejisa
- Ethiopian Public Health Institute, Tuberculosis/HIV Research Directorate, Addis Ababa, Ethiopia
| | - Mohammad Ali Mansournia
- Tehran University of Medical Sciences-International Campus, School of Public Health, Department of Epidemiology and Biostatistics, Tehran, Iran
| | - Mehdi Yaseri
- Tehran University of Medical Sciences-International Campus, School of Public Health, Department of Epidemiology and Biostatistics, Tehran, Iran
| | - Ephrem Tesfaye
- Ethiopian Public Health Institute, Tuberculosis/HIV Research Directorate, Addis Ababa, Ethiopia
| | - Million Mola
- St. Peter's Specialized Hospital, Research and Evidence Generation Directorate, Addis Ababa, Ethiopia
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Munivenkatappa S, Anil S, Naik B, Volkmann T, Sagili KD, Akshatha JS, Buggi S, Sharada MA, Kulkarni S, Chadha VK, Moonan PK. Drug-Induced Hypothyroidism during Anti-Tuberculosis Treatment of Multidrug-Resistant Tuberculosis: Notes from the Field. ACTA ACUST UNITED AC 2016; 4:105-110. [PMID: 27595122 PMCID: PMC5007858 DOI: 10.4236/jtr.2016.43013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We followed 188 euthyroidic persons undergoing treatment for multidrug resistant tuberculosis (MDR-TB) in the state of Karnataka, India to determine the incidence of hypothyroidism during anti-tuberculosis treatment. Overall, among MDR-TB patients with valid thyroid stimulating hormone (TSH) values, about 23% developed hypothyroidism (TSH value ≥10 mIU/ml) during anti-tuberculosis treatment; the majority (74%) occurring after 3 months of treatment. Among 133 patients who received a regimen that contained ethionamide, 42 (32%) developed hypothyroidism. Among 17 patients that received a regimen that contained para-aminosalicylate sodium, 6 (35%) developed hypothyroidism. Among 9 HIV positive patients on anti-retroviral treatment, 4 (44%) developed hypothyroidism. These results differ from previously reported 4% incidence of hypothyroidism amongst patients who passively reported thyroidal symptoms during treatment, suggesting routine serologic monitoring of TSH throughout the course of treatment for MDR-TB is warranted.
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Affiliation(s)
- Somashekar Munivenkatappa
- Drug Resistant Treatment Centre, Bengaluru, India; Sri Devarao Shivaram, Tuberculosis and Rajiv Gandhi Institute of Chest Diseases, Bengaluru, India
| | - Singarajipura Anil
- Revised National Tuberculosis Programme-State of Karnataka, Bengaluru, India
| | - Balaji Naik
- World Health Organization, India Country Office, New Delhi, India
| | - Tyson Volkmann
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karuna D Sagili
- International Union against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | | | - Shashidhar Buggi
- Sri Devarao Shivaram, Tuberculosis and Rajiv Gandhi Institute of Chest Diseases, Bengaluru, India
| | | | | | | | - Patrick K Moonan
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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Schaaf HS, Thee S, van der Laan L, Hesseling AC, Garcia-Prats AJ. Adverse effects of oral second-line antituberculosis drugs in children. Expert Opin Drug Saf 2016; 15:1369-81. [PMID: 27458876 DOI: 10.1080/14740338.2016.1216544] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Increasing numbers of children with drug-resistant tuberculosis are accessing second-line antituberculosis drugs; these are more toxic than first-line drugs. Little is known about the safety of new antituberculosis drugs in children. Knowledge of adverse effects, and how to assess and manage these, is important to ensure good adherence and treatment outcomes. AREAS COVERED A Pubmed search was performed to identify articles addressing adverse effects of second-line antituberculosis drugs; a general search was done for the new drugs delamanid and bedaquiline. This review discusses adverse effects associated with oral second-line antituberculosis drugs. The spectrum of adverse effects caused by antituberculosis drugs is wide; the majority are mild or moderate, but these are important to manage as it could lead to non-adherence to treatment. Adverse effects may be more common in HIV-infected than in HIV-uninfected children. EXPERT OPINION Although children may experience fewer adverse effects from oral second-line antituberculosis drugs than adults, evidence from prospective studies of the incidence of adverse events in children is limited. Higher doses of second-line drugs, new antituberculosis drugs, and new drug regimens are being evaluated in children: these call for strict pharmacovigilance in children treated in the near future, as adverse effect profiles may change.
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Affiliation(s)
- H Simon Schaaf
- a Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Stephanie Thee
- b Department of Paediatric Pneumology and Immunology , Charité, Universitätsmedizin Berlin , Berlin , Germany
| | - Louvina van der Laan
- a Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Anneke C Hesseling
- a Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Anthony J Garcia-Prats
- a Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
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Abstract
Tuberculosis (TB) remains a major public health problem, representing the second leading cause of death from infectious diseases globally, despite being nearly 100 % curable. Multidrug-resistant (MDR)-TB, a form of TB resistant to isoniazid and rifampicin (rifampin), two of the key first-line TB drugs, is becoming increasingly common. MDR-TB is treated with a combination of drugs that are less effective but more toxic than isoniazid and rifampicin. These drugs include fluoroquinolones, aminoglycosides, ethionamide, cycloserine, aminosalicyclic acid, linezolid and clofazimine among others. Minor adverse effects are quite common and they can be easily managed with symptomatic treatment. However, some adverse effects can be life-threatening, e.g. nephrotoxicity due to aminoglycosides, cardiotoxicity due to fluoroquinolones, gastrointestinal toxicity due to ethionamide or para-aminosalicylic acid, central nervous system toxicity due to cycloserine, etc. Baseline evaluation may help to identify patients who are at increased risk for adverse effects. Regular clinical and laboratory evaluation during treatment is very important to prevent adverse effects from becoming serious. Timely and intensive monitoring for, and management of adverse effects caused by, second-line drugs are essential components of drug-resistant TB control programmes; poor management of adverse effects increases the risk of non-adherence or irregular adherence to treatment, and may result in death or permanent morbidity. Treating physicians should have a thorough knowledge of the adverse effects associated with the use of second-line anti-TB drugs, and routinely monitor the occurrence of adverse drug reactions. In this review, we have compiled safety and tolerability information regarding second-line anti-TB drugs in both adults and children.
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11
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Thyroid profile status of patients treated for multidrug-resistant tuberculosis in state of Meghalaya, India. Indian J Tuberc 2015; 62:166-70. [PMID: 26600329 DOI: 10.1016/j.ijtb.2015.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 07/08/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Meghalaya has high tuberculosis burden with increasing multidrug-resistant tuberculosis (MDR-TB) cases. Drug-induced hypothyroidism is one of the well-documented adverse effects in treatment of MDR-TB, the data of which are unavailable in the population residing in this part of the Indian subcontinent. AIM This study was undertaken to assess the thyroid profile status of patients under DOTS Plus treatment and to evaluate the effects of anti-tubercular drugs on thyroid functions with respect to the pre-treatment thyroid status. METHODS A prospective study of 114 patients who initiated treatment for MDR-TB between June 2012 and August 2013 was performed. Thyroid hormones, viz., TSH, Total T3, Total T4, Free T3 and Free T4 were estimated. RESULTS Out of our study group of 114 MDR-TB patients, 15 dead patients and defaulters were excluded. So, out of 99 patients, till now, 76 patients have completed 6 months of DOTS Plus treatment and were re-evaluated for thyroid status. 52(68%) patients showed TSH levels more than the reference limit of 5.60 μIU/mL and 5(7%) patients had TSH >10 μIU/mL suggesting presence of sub-clinical hypothyroidism. CONCLUSION We suggest the need for Mandatory TSH screening at baseline and then six months interval for all patients taking DOTS Plus so that no adverse effect goes under-reported and early intervention if required should be done to maintain proper adherence.
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A review of the use of ethionamide and prothionamide in childhood tuberculosis. Tuberculosis (Edinb) 2015; 97:126-36. [PMID: 26586647 DOI: 10.1016/j.tube.2015.09.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 08/26/2015] [Accepted: 09/16/2015] [Indexed: 11/21/2022]
Abstract
Ethionamide (ETH) and prothionamide (PTH), both thioamides, have proven efficacy in clinical studies and form important components for multidrug-resistant tuberculosis treatment regimens and for treatment of tuberculous meningitis in adults and children. ETH and PTH are pro-drugs that, following enzymatic activation by mycobacterial EthA inhibit InhA, a target shared with isoniazid (INH), and subsequently inhibit mycolic acid synthesis of Mycobacterium tuberculosis. Co-resistance to INH and ETH is conferred by mutations in the mycobacterial inhA promoter region; mutations in the ethA gene often underlie ETH and PTH monoresistance. An oral daily dose of ETH or PTH of 15-20 mg/kg with a maximum daily dose of 1000 mg is recommended in children to achieve adult-equivalent serum concentrations shown to be efficacious in adults, although information on optimal pharmacodynamic targets is still lacking. Gastrointestinal disturbances, and hypothyroidism during long-term therapy, are frequent adverse effects observed in adults and children, but are rarely life-threatening and seldom necessitate cessation of ETH therapy. More thorough investigation of the therapeutic effects and toxicity of ETH and PTH is needed in childhood TB while child-friendly formulations are needed to appropriately dose children.
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Mallela AR, Koya R, Nagari SK, Mohapatra AK. Ethionamide: Unusual Cause of Hypothyroidism. J Clin Diagn Res 2015; 9:OD08-9. [PMID: 26435990 PMCID: PMC4576583 DOI: 10.7860/jcdr/2015/13531.6331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 06/26/2015] [Indexed: 11/24/2022]
Abstract
Multidrug-Resistant tuberculosis (MDR TB) is major health hazard to the people living in developing countries. As incidence rate of MDR TB has gone up, its therapy has become crucial. MDR TB therapy is known to cause multiple adverse effects however the data related to them is minimal. Hypothyroidism is one of the important adverse effects which usually manifests with vague symptoms and is frequently missed. We present a case of 24-year-old woman who was diagnosed to have MDR TB and started on ethionamide based regimen for same. After 6 months of therapy the patient had clinical symptoms suggestive of hypothyroidism, laboratory investigations confirmed it. As ethionamide is an integral component of MDR TB therapy it was continued and thyroxine replacement therapy was given with which she improved. Hypothyroidism completely resolved after 2 months of stoppage of MDR TB therapy suggesting the reversible aetiology of ethionamide.
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Affiliation(s)
- Ajay Raj Mallela
- Junior Resident, Department of Internal Medicine, Kasturba Medical College, Manipal, India
| | - Rohini Koya
- Junior Resident, Department of Internal Medicine, Kasturba Medical College, Manipal, India
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Akshata J, Swapna R, Chakraborty A, Somashekar M, Buggi S. Hypothyroidism in MDR-TB treatment – Rare occurrence but a major concern. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2015.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Andries A, Isaakidis P, Das M, Khan S, Paryani R, Desai C, Dalal A, Mansoor H, Verma R, Fernandes D, Sotgiu G, Migliori GB, Saranchuk P. High rate of hypothyroidism in multidrug-resistant tuberculosis patients co-infected with HIV in Mumbai, India. PLoS One 2013; 8:e78313. [PMID: 24194919 PMCID: PMC3806815 DOI: 10.1371/journal.pone.0078313] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 09/10/2013] [Indexed: 11/18/2022] Open
Abstract
Background Adverse events (AEs) among HIV-infected patients with multidrug-resistant tuberculosis (MDR-TB) receiving anti-TB and antiretroviral treatments (ART) are under-researched and underreported. Hypothyroidism is a common AE associated with ethionamide, p-aminosalicylic acid (PAS), and stavudine. The aim of this study was to determine the frequency of and risk factors associated with hypothyroidism in HIV/MDR-TB co-infected patients. Methods This was a prospective, observational cohort study, using routine laboratory data in a Médecins Sans Frontières (MSF) clinic in collaboration with Sewri TB Hospital, Mumbai, India. Hypothyroidism was defined as a thyroid stimulating hormone (TSH) result >10 mIU/L at least once during treatment. Patients having a baseline result and one additional result after 3 months were eligible for enrolment. Results Between October 2006 and March 2013, 116 patients were enrolled, 69 of whom were included. The median (IQR) age was 38 years (34-43) and 61% were male. By March 2013, 37/69 (54%) had hypothyroidism after at least 90 days of treatment. Age, gender, CD4 counts and stavudine-based ART were not associated with the occurrence of hypothyroidism in multivariate models. The co-administration of PAS and ethionamide was found to double the risk of hypothyroidism (RR: 1.93, 95% CI: 1.06-3.54). Discussion High rate of hypothyroidism was recorded in a Mumbai cohort of MDR-TB/HIV co-infected patients on treatment. This is a treatable and reversible AE, however, it may go undiagnosed in the absence of regular monitoring. Care providers should not wait for clinical symptoms, as this risks compromising treatment adherence. Simple, affordable and reliable point-of-care tools for measuring TSH are needed, especially in high MDR-TB burden countries. Our findings suggest the need for TSH screening at baseline, three months, six months, and every six months thereafter for HIV-infected patients on MDR-TB treatment regimens containing PAS and/or ethionamide, until newer, safer and more efficacious MDR-TB regimens become available.
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Affiliation(s)
| | | | | | | | | | | | - Alpa Dalal
- Sewri GTB Hospital, Chest Department, Mumbai, India
| | | | | | | | - Giovanni Sotgiu
- Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari-Research, Medical Education and Professional Development Unit, AOU, Sassari, Sassari, Italy
| | - Giovanni B. Migliori
- S. Maugeri Foundation, World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Tradate, Italy
| | - Peter Saranchuk
- Southern Africa Medical Unit (SAMU), Médecins Sans Frontières, Cape Town, South Africa
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Modongo C, Zetola NM. Prevalence of hypothyroidism among MDR-TB patients in Botswana. Int J Tuberc Lung Dis 2013; 16:1561-2. [PMID: 23044454 DOI: 10.5588/ijtld.12.0403] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kosack CS, Page AL, Van Hulsteijn LT, Lentjes EGWM. TSH-CHECK-1 test: diagnostic accuracy and potential application to initiating treatment for hypothyroidism in patients on anti-tuberculosis drugs. PLoS One 2012; 7:e33704. [PMID: 22442713 PMCID: PMC3307754 DOI: 10.1371/journal.pone.0033704] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 02/15/2012] [Indexed: 11/18/2022] Open
Abstract
Background Thyroid-stimulating hormone (TSH) promotes expression of thyroid hormones which are essential for metabolism, growth, and development. Second-line drugs to treat tuberculosis (TB) can cause hypothyroidism by suppressing thyroid hormone synthesis. Therefore, TSH levels are routinely measured in TB patients receiving second-line drugs, and thyroxin treatment is initiated where indicated. However, standard TSH tests are technically demanding for many low-resource settings where TB is prevalent; a simple and inexpensive test is urgently needed. Methods As a proof of concept study TSH was measured in routinely collected sera at the University Medical Center Utrecht, Netherlands, using the TSH-CHECK-1 (VEDALAB, Alençon, France), a lateral-flow rapid immunochromatographic assay with a TSH cut-off value of 10 µIU/mL, the standard threshold for initiating treatment. These results were compared with TSH levels measured by a reference standard (UniCel DXi 800 imunoassay system, Beckman Coulter, USA). Sensitivity, specificity, and likelihood ratios were then calculated. Results A total of 215 serum samples were evaluated: 107 with TSH values <10 µIU/mL and 108 with values ≥10 µIU/mL. TSH-CHECK-1 test sensitivity was found to be 100.0% (95% CI: 96.6–100.0) and specificity was 76.6% (95% CI: 67.5–84.3). Predictive values (PV) were modelled for different levels of prevalence. For a prevalence of 10% and 50%, the positive PV was 32.2% (95% CI: 25.0–39.7%) and 81.1% (95% CI: 75.0–85.5%), respectively; the negative PV was 100% (95% CI: 98.9–100%) and 100% (95% CI: 91.3–100%) respectively. Discussion/Conclusions The TSH-CHECK-1 rapid test was practical and simple to perform but difficult to interpret on weak positive results. All sera with TSH≥10 µIU/mL were correctly identified, but the test lacked sufficient specificity. Given its excellent negative PV in this evaluation, the test shows promise for ruling out hypothyroidism. However, so far it appears that samples testing positive with TSH-CHECK-1 would require confirmation using another method.
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Affiliation(s)
- Cara S Kosack
- Médecins sans Frontières, Amsterdam, The Netherlands.
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Seddon JA, Hesseling AC, Marais BJ, McIlleron H, Peloquin CA, Donald PR, Schaaf HS. Paediatric use of second-line anti-tuberculosis agents: a review. Tuberculosis (Edinb) 2011; 92:9-17. [PMID: 22118883 DOI: 10.1016/j.tube.2011.11.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 09/25/2011] [Accepted: 11/01/2011] [Indexed: 11/18/2022]
Abstract
Childhood multidrug-resistant tuberculosis (MDR-TB) is an emerging global epidemic. With the imminent roll-out of rapid molecular diagnostic tests, more children are likely to be identified and require treatment. As MDR-TB is resistant to the most effective first-line drugs, clinicians will have to rely on second-line medications which are less effective and often associated with more pronounced adverse effects than first-line therapy. Despite the fact that most of these agents were discovered many years ago, robust information is lacking regarding their pharmacokinetic and pharmacodynamic properties, adverse effects and drug interactions, especially in children. Children differ from adults in the way that drugs are administered, the manner in which they are metabolised and in the adverse effects experienced. The interaction of these drugs with human immunodeficiency virus infection and antiretroviral therapy is also poorly documented. This article reviews the available second-line drugs currently used in the treatment of MDR-TB in children and discusses medication properties and adverse effects while potential interactions with antiretroviral therapy are explored.
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Affiliation(s)
- James A Seddon
- Desmond Tutu TB Centre, Faculty of Health Sciences, Stellenbosch University, South Africa.
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Ashby CR, Jodlowski TZ, Sym D. Medications for Extensively Drug-Resistant Tuberculosis: Back to the Future? J Pharm Technol 2008. [DOI: 10.1177/875512250802400205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To reexamine the existing medications for the potential treatment of extensively drug-resistant tuberculosis (XDR-TB), based on susceptibility data, and to identify potential future medications from the literature. Data Sources: Relevant information was identified through a search of MEDLINE (1966–November 2007), PubMed (1955–November 2007), American Search Premier (1975–November 2007), International Pharmaceutical Abstracts (1960–November 2007), Science Citation Index Expanded (1996–November 2007), Cochrane Databases (publications archived until November 2007), and various tertiary sources as listed in the references, using the terms extensively drug-resistant tuberculosis (XDR-TB), ethambutol, pyrazinamide, para-aminosalicylic acid, cycloserine, linezolid, diarylquinoline, nitroimidazopyran, fluoroquinolones, β-lactams, new treatments, and ethionamide alone or in combination regimens. Study Selection and Data Extraction: After identification of the relevant information, the data presented in this article were selected based on clinical relevance and value of information. Data Synthesis: Based on susceptibility data, pyrazinamide, ethambutol, para-aminosalicylic acid, cycloserine, and ethionamide may be used for the treatment of tuberculosis. However, due to the emergence of XDR-TB, many of these agents are no longer successful treatment regimens. We have found limited data supporting potential future use of β-lactams, clarithromycin, and linezolid in resistant TB infections. TMC207, nitroimidazopyran, and SQ109 compounds may also prove to be viable options in the near future for treatment of tuberculosis, especially in cases with resistance to mainstay medications. Conclusions: Extensively resistant tuberculosis appears to be a potentially catastrophic disease if allowed to spread. Due to its resistance profile, very few potentially effective agents are available, calling attention to this growing problem.
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Affiliation(s)
- Charles R Ashby
- CHARLES R ASHBY JR PhD, Professor, St. John's University College of Pharmacy and Allied Health Professions, Queens, NY
| | - Tomasz Z Jodlowski
- TOMASZ Z JODLOWSKI PharmD BCPS, Assistant Clinical Professor, St. John's University College of Pharmacy and Allied Health Professions, Queens, NY; Infectious Diseases Clinical Pharmacist, Beth Israel Medical Center, New York, NY
| | - Donna Sym
- DONNA SYM BS PharmD, Assistant Clinical Professor, St. John's University College of Pharmacy and Allied Health Professions; Clinical Preceptor, North Shore University Hospital, Manhasset, NY
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Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN, Fujiwara P, Grzemska M, Hopewell PC, Iseman MD, Jasmer RM, Koppaka V, Menzies RI, O'Brien RJ, Reves RR, Reichman LB, Simone PM, Starke JR, Vernon AA. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med 2003; 167:603-62. [PMID: 12588714 DOI: 10.1164/rccm.167.4.603] [Citation(s) in RCA: 1201] [Impact Index Per Article: 57.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Barber PG, Goldman WM, Avicolli AJS, Smith R, Rairden N, Maragni O, Chirico J, Mangone C. Antitubercular drugs. Tuberculosis (Edinb) 1995. [DOI: 10.1007/978-1-4899-2869-6_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
The hepatotoxicity induced by administration of ethionamide and thionicotinamide (TNA) was shown to be decreased by pre-administration of methimazole (MMI). Pre-administration of MMI was also shown to decrease the levels of excretion of TNA S-oxide. This indicates that thioamide S-oxidation, mediated by the flavin-containing mono-oxygenase, may be linked to the initiation of hepatotoxicity induced by these thioamides. SK&F-525-A, the cytochrome P-450 inhibitor, did not affect either thioamide-induced toxicity or levels of excretion of TNA S-oxide; however, the role of the P-450 isoenzymes cannot be totally ruled out.
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Affiliation(s)
- M J Ruse
- School of Biochemistry, University of Birmingham, U.K
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