Prevalence, risk factors and treatment outcomes of fluoroquinolones-associated tendinopathy in tuberculosis patients at university hospital, Thailand.

ABSTRACT

Background: Tuberculosis (TB) is an epidemic disease in Thailand. Fluoroquinolones are used to treat TB and have a lengthy treatment course. Therefore, many patients may have adverse effects from these medications. Tendinopathy has been reported as a significant adverse effect of fluoroquinolones. Although the mechanism of tendinopathy from fluoroquinolones is not fully understood, it can progress to a more serious consequence such as a ruptured tendon which can result in morbidity if not treated effectively. Methods: This study was a single-centered, retrospective descriptive study conducted in patients at a tertiary-level university hospital in Thailand. TB patients who received fluoroquinolones for the treatment of TB from January 2017 to December 2019 were enrolled. This study assessed the prevalence, clinical characteristics, treatment, treatment outcomes for fluoroquinolones-associated tendinopathy, and treatment outcomes of TB. Results: During the study period, 184 participants that were diagnosed with TB and used fluoroquinolones were enrolled in the study. 34 (18.5%) participants developed tendinopathy. The risk factors that were associated with fluoroquinolones-associated tendinopathy were younger age (<60 years) (Odd ratio (OR) 3.61; 95% CI 1.16-11.23), female (OR 3.54; 95% CI 1.58-7.90), and prolonged usage of levofloxacin (>180 days) (OR 2.61; 95%CI 1.12-6.08). All participants who developed tendinopathy received conservative treatment; the dose of fluoroquinolones was reduced in 9 (26.4%) participants, fluoroquinolones were discontinued in 7 (20.6%) participants and the rest of the participants (n = 18; 52.9%) had conservative treatment. After conservative treatment, 25 (73.5%) participants recovered from tendinopathy. For the TB treatment, 27 (79.4%) participants in the tendinopathy group completed TB treatment and none of them experienced treatment failure. On the other hand, 89 (59.3%) participants in the no tendinopathy group had completed their TB treatment and 3 (2%) of them experienced treatment failure. Conclusions: The prevalence of fluoroquinolones-associated tendinopathy was not uncommon, and the risk of fluoroquinolones-associated tendinopathy was high in young and female patients. Levofloxacin use was related to an elevated risk of developing tendinopathy, which was dose- and duration-dependent. Conservative treatment, reducing the dose or discontinuation of fluoroquinolones successfully improved the symptoms of tendinopathy. Fluoroquinolones-associated tendinopathy did not affect the treatment of TB.