Arshad JAVAID, Faheem JAN, Mazhar Ali KHA, Mifra RAUF, Mir Azam KHA, Anila BASİT, Sumaira MEHREEN

Pakistan’da çok ilaca dirençli tüberküloz için toplum temelli tedavi alan hastalarda advers etki gelişimi

Giriş: Çok ilaca dirençli tüberkülozun (ÇİD-TB) yüksek oranda görüldüğü 22 ülke arasında Pakistan dördüncü sıradadır. ÇİD-TB’nin Pakistan’da artan oranı ilaca dirençli tüberkülozda etkin tedavi programlarının önemini vurgulamaktadır. ÇİD-TB’nin klinik tedavisi sıklıkla advers etkilere sebep olan uzun çok ilaçlı rejimler gerektirir. Materyal ve Metod: Bu retrospektif olgu serisi araştırmasına Ocak 2014-Nisan 2015 tarihleri arasında üçüncü basamak hastanesi olan Lady Reading Hospital (LRH) Peshawar Pakistan’da bulunan Programmatic Management of Drug Resistant TB (PMDT) ünitesine başvuran tüm hastalar dahil edildi. Bu araştırmada tedavi ilişkili advers etki ve bu etkilerle ilişkili faktörler değerlendirildi. Ayrıca ilaç rejimlerinin değiştirilme sıklığı ve sebepleri incelendi. Ayrıca advers olayların tedavi üzerine olumsuz etkileri ve advers etkiler ile ÇİDTB tedavisi kesilmesi ilişkisi değerlendirildi. Bulgular: Analizde 200 hastanın son verileri kullanıldı. Hastaların %52.5’i kadın, %81.5’i ≤ 44 yaşındaydı. Yüz elli beş (%77.2) hasta tedavi süresince en az bir kez advers olay ile karşılaştı. En sık görülen %70 olguda psikiyatrik olaylar, en az görülen %7.5 olguda deri döküntüsüydü. %16.5 olguda advers etkiler nedeniyle ilaç dozunda değişiklik görülürken %13.5 olguda en az bir ilaca geçici olarak ara verildi. Genç yaş ve başlangıçta akciğer kavitesi olması advers etki gelişimiyle ilişkili bulundu. Ayrıca advers etki ve tedavi başarısı arasında da ilişki saptandı (OR= 0.480, 0.236-0.978, p= 0.041). Sonuç: PMDT-LRH Peshawar’da tedavi edilen ÇİD-TB olgularında advers etkiler sıktır. Genç ve akciğerinde kavite olan olgular advers etki gelişimi açısından yakın takip edilmelidir.

Occurrence of adverse events in patient receiving community-based therapy for multidrug-resistant tuberculosis in Pakistan

Introduction: Pakistan ranks 4th among 22 multidrug resistant tuberculosis (MDR-TB) high burden countries. The increasing rate ofMDR-TB in Pakistan underscores the importance of effective treatment programs of drug-resistant TB. Clinical management of MDRTB requires prolonged multidrug regimens that often cause adverse events (AEs).Materials and Methods: This retrospective case series study include all patients who were enrolled for MDR-TB treatment duringJanuary 2014 till April 2015 at Programmatic Management of Drug Resistant TB (PMDT) unit at tertiary care hospital, Lady ReadingHospital (LRH) Peshawar Pakistan. In this study we sought to ascertain the occurrence of treatment related adverse events and factorsassociated with these events. Here we also examined the frequency of and reasons for changing drug regimens. We further sought todetermine whether the occurrence of adverse events negatively impacts the treatment outcome and management of adverse effectswithout requiring the discontinuation of MDR-TB therapy.Results: At the time of analysis final outcomes of all 200 enrolled patients exist. Among these 52.5% were females and (81.5%) wereaged ≤ 44 years. Among study cases 155 (77.2%) experienced atleast one adverse event during treatment. The most commonlyreported events were psychiatric issues (70%) whereas the lesscommon was skin rashes (7.5%). A change in drug dose due toadverse events occurred in 16.5% cases, while 13.5% cases had atleast one drug discontinued temporarily. Younger age and lungcavities at baseline were positive association with occurrence ofadverse events. Association was also found between adverse eventsand treatment outcomes (OR 0.480, 0.236-0.978, p= 0.041).Conclusion: Adverse events were prevalent among MDR-TB patients treated at PMDT-LRH Peshawar. All patients who were youngeraged and cavitory lungs should be closely monitored for occurrence of adverse events.

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