Study finds increased risk of liver injury with some TB medications
A newly recommended treatment for latent tuberculosis (TB) infection can cause liver injury, and therefore needs to be used with great caution and frequent monitoring, according to a UCSF-led, multi-center study.
The research reporting the increased liver injury from the drugs, rifampin and pyrazinamide, was conducted by investigators at UCSF, Boston University, and Emory University and appears in the October 15 issue of the Annals of Internal Medicine.
The study is the first large-scale clinical trial to compare the newly recommended and shorter duration treatment – two months of rifampin and pyrazinamide -- with the standard treatment, six months of isoniazid, to treat patients with latent TB infection.
"We found that patients taking the two-drug treatment had a much higher rate of major liver injury than those who took the standard treatment of isoniazid," said principal investigator Robert M. Jasmer, MD, UCSF assistant professor of medicine, who treats patients in the division of tuberculosis control at San Francisco General Hospital Medical Center (SFGHMC).
Caused by the organism Mycobacterium tuberculosis, TB is a chronic bacterial infection that usually causes disease in the lungs but also attacks other organs. TB is usually dormant (or latent) in the body for years, but around ten percent of latently infected individuals will develop active TB at some time in their lives. It is estimated that 10-15 million people in the U.S. and 2 billion people in the world are infected with TB bacteria. People who have been recently infected or have a condition that increases their chances of developing active TB are recommended to undergo treatment for latent TB infection to prevent them from developing active TB in the future, said Jasmer.
Study findings showed that eight percent of patients taking the rifampin and pyrazinamide regimen developed significant liver injury compared with only one percent of those taking isoniazid. Other side effects and the percentage completing treatment were similar between the two groups.
Previous studies had shown that the two-drug treatment was safe and effective in HIV-infected persons with latent TB infection, so experts recommended this treatment as a new option for all adults in the U.S. in 2000, explained Jasmer. However, the Centers for Disease Control and Prevention (CDC) received reports of eight deaths due to liver failure among patients treated with the two-drug regimen. These deaths led to new recommendations to monitor patients closely every two weeks who are prescribed the rifampin and pyrazinamide treatment.
In the study, known as the SCRIPT (Short-Course Rifampin and Pyrazinamide for TB Infection) Study, 589 patients were enrolled and assigned to treatment with either the rifampin and pyrazinamide regimen or isoniazid. All patients underwent frequent monitoring for side effects and blood tests to detect liver damage. No patients in the study were hospitalized for liver disease, and all had complete resolution of their liver abnormalities after discontinuation of the medications when necessary.
"Our study confirms the new CDC recommendations for frequent monitoring of patients treated with the two-drug regimen so that they are evaluated every two weeks, including testing their blood for markers of liver injury. The vast majority of patients did fine and completed the treatment without major side effects, but laboratory monitoring is essential to detect those with early liver injury and prevent progression to severe toxicity," Jasmer said.
Maureen McInaney | EurekAlert!
The most recent press releases about innovation >>>
Die letzten 5 Focus-News des innovations-reports im Überblick:
A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.
Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...
In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.
“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...
The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.
The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...
Broadband rotational spectroscopy unravels structural reshaping of isolated molecules in the gas phase to accommodate water
In two recent publications in the Journal of Chemical Physics and in the Journal of Physical Chemistry Letters, researchers around Melanie Schnell from the Max...
The efficiency of power electronic systems is not solely dependent on electrical efficiency but also on weight, for example, in mobile systems. When the weight of relevant components and devices in airplanes, for instance, is reduced, fuel savings can be achieved and correspondingly greenhouse gas emissions decreased. New materials and components based on gallium nitride (GaN) can help to reduce weight and increase the efficiency. With these new materials, power electronic switches can be operated at higher switching frequency, resulting in higher power density and lower material costs.
Researchers at the Fraunhofer Institute for Solar Energy Systems ISE together with partners have investigated how these materials can be used to make power...