Hepatotoxicity of pyrazinamide: cohort and case-control analyses.
Am J Respir Crit Care Med
; 177(12): 1391-6, 2008 Jun 15.
Article
in En
| MEDLINE
| ID: mdl-18388355
ABSTRACT
RATIONALE Relatively little is known about the hepatotoxicity of pyrazinamide. OBJECTIVES:
We compared continuation-phase regimens incorporating pyrazinamide, isoniazid, and/or rifampin with those containing isoniazid and rifampin to evaluate the hepatotoxicity of pyrazinamide.METHODS:
Cohort and nested case-control analyses were conducted on a cohort of 3,007 patients with active tuberculosis (TB) managed at government chest clinics under a TB control program with treatment started from January 1 through June 30, 2001. Cases included all patients with probable hepatotoxicity from 12 or more weeks after starting treatment. Hepatotoxicity was considered probable when serum alanine transaminase exceeded three times the upper limit of normal. Each case was matched by sex and age with three control subjects selected randomly from the rest of the cohort. Treatment regimens of cases within 4 weeks preceding hepatotoxicity were compared with those of matched control subjects in comparable periods relative to the date of commencing treatment. MEASUREMENTS AND MAINRESULTS:
Hepatotoxicity occurred in 150 (5.0%) patients at any time including 48 (1.6%) cases. From 12 or more weeks after starting treatment, the estimated risk of hepatotoxicity was 2.6% for regimens incorporating pyrazinamide, isoniazid, and/or rifampin, and 0.8% for standard regimens containing isoniazid and rifampin. Multivariable conditional logistic analysis showed a significant association between hepatotoxicity and, respectively, hepatitis B, previous hepatotoxicity, and treatment regimens. The adjusted odds ratio (95% confidence interval) of hepatotoxicity for regimens incorporating pyrazinamide, isoniazid, and/or rifampin relative to standard regimens was 2.8 (1.4-5.9).CONCLUSIONS:
Adding pyrazinamide to isoniazid and rifampin increases the risk of hepatotoxicity appreciably.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Pyrazinamide
/
Tuberculosis
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Chemical and Drug Induced Liver Injury
/
Antitubercular Agents
Type of study:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Am J Respir Crit Care Med
Journal subject:
TERAPIA INTENSIVA
Year:
2008
Type:
Article
Affiliation country:
China