Poor treatment outcome and associated risk factors among patients with isoniazid mono-resistant tuberculosis: A systematic review and meta-analysis

Abstract

Background To date, isoniazid mono-resistant tuberculosis (TB) is becoming an emerging global public health problem. It is associated with poor treatment outcome. Different studies have assessed the treatment outcome of isoniazid mono-resistant TB cases, however, the findings are inconsistent and there is limited global comprehensive report. Thus, this study aimed to assess the poor treatment outcome and its associated risk factors among patients with isoniazid mono-resistant TB. Methods Studies that reported the treatment outcomes and associated factors among isoniazid mono-resistant TB were searched from electronic databases and other sources. We used Joana Briggs Institute critical appraisal tool to assess the study’s quality. We assessed publication bias through visual inspection of the funnel plot and confirmed by Egger’s regression test. We used STATA version 17 for statistical analysis. Results Among 347 studies identified from the whole search, data were extracted from 25 studies reported from 47 countries. The pooled successful and poor treatment outcomes were 78% (95%CI; 74%-83%) and 22% (95%CI; 17%-26%), respectively. Specifically, complete, cure, treatment failure, mortality, loss to follow-up and relapse rates were 34%(95%CI; 17%-52%), 62% (95%CI; 50%-73%), 5% (95%CI; 3%-7%), 6% (95%CI; 4%-8%), 12% (95%CI; 8%-17%), and 1.7% (95%CI; 0.4%-3.1%), respectively. Higher prevalence of pooled poor treatment outcome was found in the South East Asian Region (estimate; 40%, 95%C; 34%-45%), and African Region (estimate; 33%, 95%CI; 24%-42%). Previous TB treatment (OR; 1.74, 95%CI; 1.15–2.33), having cancer (OR; 3.53, 95%CI; 1.43–5.62), and being initially smear positive (OR; 1.26, 95%CI; 1.08–1.43) were associated with poor treatment outcome. While those patients who took rifampicin in the continuation phase (OR; 0.22, 95%CI; 0.04–0.41), had extrapulmonary TB (OR; 0.70, 95%CI; 0.55–0.85), and took second-line injectable drugs (OR; 0.54, 95%CI; 0.33–0.75) had reduced risk of poor treatment outcome. Conclusion Isoniazid mono-resistant TB patients had high poor treatment outcome. Thus, determination of isoniazid resistance pattern for all bacteriologically confirmed TB cases is critical for successful treatment outcome. PROSPERO registration number: CRD42022372367

Spatial pattern of isoniazid-resistant tuberculosis and its associated factors among a population with migrants in China: a retrospective population-based study

“…Additionally, our results unveiled that Hr-TB outcomes were worse compared to those of DS-TB. This observation was similar to the results of studies in other countries and regions ( 39 – 41 ). These findings may be due to potentially limited management strategies for TB patients ( 42 ), particularly concerning the management of previously treated cases and treatment strategies for Hr-TB.…”

The positivity rates and drug resistance patterns of Mycobacterium tuberculosis using nucleotide MALDI-TOF MS assay among suspected tuberculosis patients in Shandong, China: a multi-center prospective study

“…In addition, a substantial number of patients have more complicated conditions and may also have a history of other infections for which similar antibiotics have been used. Currently, isoniazid mono-resistant TB is emerging as a growing global public health concern due to its association with poor treatment outcomes ( 20 ). The incidence of isoniazid mono-resistant TB is increasing progressively more frequently than rifampicin mono-resistant TB, and an estimated 11% of TB patients are isoniazid-resistant and rifampicin-sensitive, globally ( 21 ).…”

How We Treat Drug-Susceptible Pulmonary Tuberculosis: A Practical Guide for Clinicians

“…Rifampicin, one of the cornerstone drugs of DS-TB treatment, may be responsible for various side effects, including cutaneous ones such as flushing on the face and neck, rash or itching, which are usually mild and self-limiting. Hepatitis, and immunologically mediated thrombocytopenia, known since 1970, usually occurs during intermittent treatment with rifampicin and can cause purpura or abnormal bleeding [82,83]. This condition can be reversible with the prompt suspension of the drug [82].…”

“…Furthermore, less frequent adverse effects related to rifampicin include shock, shortness of breath, renal failure and hemolytic anemia. In case of the occurrence of any of the latter, immediate suspension of the drug is indicated with no possibility of reintroduction [83]. The incidence of gastrointestinal events (e.g., nausea, loss of appetite, mild abdominal pain, vomiting and diarrhea) due to rifampicin is variable and can be prevented by taking the drug before meals [84][85][86].…”