Retrospective comparative study of myelosuppression associated with linezolid and tedizolid therapy

Myelosuppression is a major adverse event associated with linezolid (LZD). Tedizolid (TZD) has also been linked to mitochondrial toxicity, a key mechanism underlying myelosuppression. However, direct clinical comparisons between LZD and TZD remain limited. We compared the incidence of anemia and thrombocytopenia between the two agents.

We retrospectively evaluated patients who received LZD or TZD for ≥7 days at Aichi Medical University Hospital. Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline characteristics in both the overall cohort and a cohort restricted to common indications, defined as excluding respiratory infections and meningitis. Anemia was defined as a ≥30% decrease in hemoglobin or a minimum level <8.0 g/dL. Thrombocytopenia was defined as a ≥30% decrease in platelet count or a minimum level < × 10⁵μL.

After IPTW adjustment in the overall cohort, effective sample sizes were 109.9 (LZD) and 120.6 (TZD). No significant differences were observed in anemia (6.5% vs. 4.2%; odds ratio [OR]:1.53; 95% confidence interval [CI]:0.50-4.70; p = 0.45) or thrombocytopenia (14.0% vs. 6.5%; OR:2.27; 95% CI:0.94-5.49; p = 0.06). In the IPTW-adjusted cohort restricted to common indications, effective sample sizes were 79.8 (LZD) and 86.3 (TZD). In contrast, anemia (16.3% vs. 4.7%; OR:3.60; p < 0.05) and thrombocytopenia (23.3% vs. 6.9%; OR:3.85; p < 0.01) were significantly more frequent in the LZD group. Among patients on hemodialysis, both outcomes were significantly higher in the LZD group across cohorts.

TZD demonstrated a lower risk of myelosuppression than LZD, particularly in patients undergoing hemodialysis.