Hepatotoxicity from antituberculous therapy in the elderly: a systematic review

Area of Science:

• Hepatology
• Infectious Diseases
• Geriatrics

Background:

• Tuberculosis (TB) disproportionately affects the elderly in the U.S.
• Older adults are at increased risk for adverse drug reactions.
• Hepatotoxicity is a significant concern in TB treatment.

Purpose of the Study:

• To determine if advanced age is a risk factor for drug-induced hepatotoxicity.
• To compare hepatotoxicity risk in TB patients over 60 versus those under 60.
• To evaluate the safety of first-line TB drugs in elderly populations.

Main Methods:

• Systematic literature review of multiple databases (MEDLINE, Cochrane, CINAHL, Science Citation Index Expanded) from 1970-2011.
• Meta-analysis using random effects model.
• Comparison of hepatotoxicity rates between age groups (over 60 vs. under 60).

Main Results:

• Thirty-eight studies with 40,034 participants and 1208 hepatotoxicity cases were analyzed.
• Active TB treatment showed an odds ratio of 1.32 (95% CI: 1.04-1.68) for hepatotoxicity in older adults (p=0.024).
• Latent TB infection (LTBI) treatment revealed a significantly higher odds ratio of 4.14 (95% CI: 2.21-7.74) for hepatotoxicity in those over 60 (p<0.001).

Conclusions:

• Patients over 60 exhibit a significantly elevated risk of hepatotoxicity from TB medications.
• A modified, gentler treatment regimen is recommended for elderly TB patients.
• Optimizing treatment in older adults can enhance health outcomes and public health safety.