Hepatotoxicity from antituberculous therapy in the elderly: A systematic review - 13/03/15
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Summary |
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.
Le texte complet de cet article est disponible en PDF.Keywords : Tuberculosis, Latent tuberculosis, Therapy, Treatment, Elderly, Hepatotoxicity, Aging, Systematic review, Toxicity, Antituberculous
Plan
Vol 95 - N° 2
P. 112-122 - mars 2015 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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