Baseline abnormal liver function tests are more important than age in the development of isoniazid‐induced hepatoxicity for patients receiving preventive therapy for latent tuberculosis infection

Gray, Emma L; Goldberg, Hazel

doi:10.1111/imj.12979

Cited by 17 publications

(16 citation statements)

References 25 publications

(30 reference statements)

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“…In a systematic review of age-related risk of hepatotoxicity by treating LTBI in 2010, the overall rates of hepatotoxicity were low; associated hospitalisation or mortality was extremely uncommon [46]. The use of IPT was concluded as safe in older patients with close clinical or biochemical monitoring and education [46], which had also been documented by recent studies [45, 47]. …”

Section: Discussionmentioning

confidence: 95%

“…However, in most cases of serious toxicity, the patient either was not monitored for clinical or biochemical toxicity, continued to take the drug without specific guidance, or had complicating underlying liver disease or alcohol abuse. Abnormal liver function was found with more impacts than age on the development of isoniazid-induced hepatotoxicity [45]. In a systematic review of age-related risk of hepatotoxicity by treating LTBI in 2010, the overall rates of hepatotoxicity were low; associated hospitalisation or mortality was extremely uncommon [46].…”

Section: Discussionmentioning

confidence: 99%

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The strategic framework of tuberculosis control and prevention in the elderly: a scoping review towards End TB targets

Chung

Leung

et al. 2017

Infect Dis Poverty

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With the rapid pace of population ageing, tuberculosis (TB) in the elderly increasingly becomes a public health challenge. Despite the increasing burden and high risks for TB in the elderly, targeted strategy has not been well understood and evaluated. We undertook a scoping review to identify current TB strategies, research and policy gaps in the elderly and summarized the results within a strategic framework towards End TB targets. Databases of Embase, MEDLINE, Global health and EBM reviews were searched for original studies, review articles, and policy papers published in English between January 1990 and December 2015. Articles examining TB strategy, program, guideline or intervention in the elderly from public health perspective were included.Nineteen articles met the inclusion criteria. Most of them were qualitative studies, issued in high- and middle-income countries and after 2000. To break the chain of TB transmission and reactivation in the elderly, infection control, interventions of avoiding delay in diagnosis and containment are essential for preventing transmission, especially in elderly institutions and aged immigrants; screening of latent TB infection and preventive therapy had effective impacts on reducing the risk of reactivation and should be used less reluctantly in older people; optimizing early case-finding with a high index of suspicion, systematic screening for prioritized high-risk groups, initial empirical and adequate follow-up treatment with close monitoring and evaluation, as well as enhanced programmatic management are fundamental pillars for active TB elimination. Evaluation of TB epidemiology, risk factors, impacts and cost-effectiveness of interventions, adopting accurate and rapid diagnostic tools, shorter and less toxic preventive therapy, are critical issues for developing strategy in the elderly towards End TB targets.TB control strategies in the elderly were comprehensively mapped in a causal link pathway. The framework and principals identified in this study will help to evaluate and improve current program, develop targeted strategy, as well as raise more discussions on the research priority settings and policy transitions. Given the scarceness of policy and evaluated interventions, as well as the unawareness of shifting TB epidemiology and strategy especially in developing countries, the increasing need of a ready TB program for the elderly warrants further research.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-017-0284-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

The strategic framework of tuberculosis control and prevention in the elderly: a scoping review towards End TB targets

Chung

Leung

et al. 2017

Infect Dis Poverty

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“…29 There was also a similar prevalence of grade 2 and 3 liver toxicity events compared to the 6 month open label phase of the BOTUSA study. 30 …”

Section: Discussionmentioning

confidence: 66%

Implementing isoniazid preventive therapy in a tuberculosis treatment-experienced cohort on ART

Maharaj

Gengiah

Yende‐Zuma

et al. 2017

int j tuberc lung dis

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SETTING Urban clinical research site in Durban, South Africa OBJECTIVE To describe the outcomes associated with implementation of isoniazid preventive therapy (IPT) in a cohort of TB treatment experienced HIV infected patients on antiretroviral therapy (ART). DESIGN We conducted a secondary analysis of data collected between October 2009 and October 2013 from patients enrolled in a prospective cohort study conducted in Durban, South Africa. RESULTS There were 402 patients enrolled in the parent study. Of these 344 (85.6%) were eligible to receive IPT and of whom 212 (61.6%) initiated IPT. Among those that initiated IPT, 184 (86.8%) completed the six month course, 24 (11.3%) permanently discontinued IPT and of these, 3.8% discontinued due to side effects. More women (n=130; 61.3%) initiated IPT (p=0.001) than men. Overall median adherence to IPT was 97.6% (IQR: 94.2 – 99.4). There were 22 cases of incident TB in this cohort: 13 occurred prior to IPT and nine after IPT (incidence rate ratio 0.67; 95% CI 0.29–1.58; p=0.362). CONCLUSIONS IPT implementation amongst ART and TB treatment experienced patients was well tolerated with good completion rates and fewer TB cases diagnosed after IPT exposure.

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“…Among them, the risk of hepatotoxicity and mortality in the elderly is mainly concerned. However, recent studies demonstrated abnormal liver function absent of monitoring and quick response had more impacts than age on the development of isoniazid-induced hepatotoxicity [ 50 , 73 ]. In a systematic review of the age-related risk of hepatotoxicity by treating LTBI, the overall rates of hepatotoxicity were low; associated hospitalization or mortality was extremely uncommon [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

Screening for latent and active tuberculosis infection in the elderly at admission to residential care homes: A cost-effectiveness analysis in an intermediate disease burden area

Yip

Leung

et al. 2018

PLoS ONE

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BackgroundTuberculosis (TB) in the elderly remains a challenge in intermediate disease burden areas like Hong Kong. Given a higher TB burden in the elderly and limited impact of current case-finding strategy by patient-initiated pathway, proactive screening approaches for the high-risk group could be optimal and increasingly need targeted economic evaluations. In this study, we examined whether and under what circumstance the screening strategies are cost-effective compared with no screening strategy for the elderly at admission to residential care homes.MethodsA decision analytic process based on Markov model was adopted to evaluate the cost-effectiveness of four strategies: (i) no screening, (ii) TB screening (CXR) and (iii) TB screening (Xpert) represent screening for TB in symptomatic elderly by chest X-ray and Xpert® MTB/RIF respectively, and (iv) LTBI/TB screening represents screening for latent and active TB infection by QuantiFERON®-TB Gold In-Tube and chest X-ray. The target population was a hypothetical cohort of 65-year-old people, using a health service provider perspective and a time horizon of 20 years. The outcomes were direct medical costs, life-years and quality-adjusted life-years (QALYs) measured by incremental cost-effectiveness ratio (ICER).ResultsIn the base-case analysis, no screening was the most cost-saving; TB screening (CXR) was dominated by TB screening (Xpert); LTBI/TB screening resulted in more life-years and QALYs accrued. The ICERs of LTBI/TB screening were US$19,712 and US$29,951 per QALY gained compared with no screening and TB screening (Xpert), respectively. At the willingness-to-pay threshold of US$50,000 per QALY gained, LTBI/TB screening was the most cost-effective when the probability of annual LTBI reactivation was greater than 0.155% and acceptability of LTBI/TB screening was greater than 38%. In 1,000 iterations of Monte Carlo simulation, the probabilities of no screening, TB screening (CXR), TB screening (Xpert), and LTBI/TB screening to be cost-effective were 0, 1.3%, 20.1%, and 78.6% respectively.ConclusionsScreening for latent and active TB infection in Hong Kong elderly people at admission to residential care homes appears to be highly effective and cost-effective. The key findings may be the next key factor to bring down TB endemic in the elderly population among intermediate TB burden areas.

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Baseline abnormal liver function tests are more important than age in the development of isoniazid‐induced hepatoxicity for patients receiving preventive therapy for latent tuberculosis infection

Cited by 17 publications

References 25 publications

The strategic framework of tuberculosis control and prevention in the elderly: a scoping review towards End TB targets

The strategic framework of tuberculosis control and prevention in the elderly: a scoping review towards End TB targets

Implementing isoniazid preventive therapy in a tuberculosis treatment-experienced cohort on ART

Screening for latent and active tuberculosis infection in the elderly at admission to residential care homes: A cost-effectiveness analysis in an intermediate disease burden area

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