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Late effects following isoniazid therapy

J D Boice, J F Fraumeni

American Journal of Public Health

|September 1, 1980

Summary

Isoniazid treatment for tuberculosis showed no increased cancer deaths in women. However, it was linked to more liver cirrhosis deaths, indicating potential chronic liver complications from this tuberculosis therapy.

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Area of Science:

Pulmonary Medicine
Oncology
Hepatology

Background:

Pulmonary tuberculosis treatment historically involved long-term medication.
Assessing the long-term safety of tuberculosis drugs, including cancer risk and liver effects, is crucial.

Purpose of the Study:

To evaluate the long-term cancer mortality risk associated with isoniazid (isonicotinic acid hydrazide = INH) treatment for pulmonary tuberculosis.
To investigate potential adverse effects, specifically liver cirrhosis, linked to INH therapy.

Main Methods:

A cohort of 338 women treated with INH for pulmonary tuberculosis in Massachusetts was followed for a mean of 12.9 years (up to 23 years).
Cancer and liver cirrhosis mortality rates in the INH-treated group were compared to expected rates and to a control group of 1,090 patients not receiving INH.
Cancer deaths in the control group were analyzed for contributing factors, including radiogenic effects from chest fluoroscopies.

Main Results:

No excess cancer deaths were observed among the 338 women treated with INH (8 observed vs. 8.3 expected).
An excess of cancer deaths (54 vs. 35.7) occurred in the 1,090 patients not receiving INH, partly attributed to radiogenic breast cancer from chest fluoroscopies.
Significantly increased deaths from liver cirrhosis (5 vs. 0.8) were observed in patients treated with INH.

Conclusions:

Isoniazid (isonicotinic acid hydrazide = INH) treatment for pulmonary tuberculosis does not appear to increase cancer mortality in women.
INH therapy may be associated with an increased risk of liver cirrhosis, suggesting potential for chronic liver disease.
Careful monitoring for liver complications is recommended during and after isoniazid treatment for tuberculosis.

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