Adverse reactions among patients being treated for MDR-TB in Tomsk, Russia.
BACKGROUND
Treatment of multidrug-resistant tuberculosis (MDR-TB) is challenging because of the toxicity of second-line medications. Little is known about whether adverse events impact treatment outcome.


METHODS
We conducted a retrospective case series of 244 MDR-TB patients enrolled in Tomsk between 10 September 2000 and 10 September 2002. Adverse reactions were determined by laboratory data and/or clinical criteria. A multiple logistic regression model was performed to determine whether the occurrence of adverse reactions was associated with poor treatment outcome.


RESULTS
In this cohort, 76.0% were cured, 6.6% failed, 4.9% died and 11.5% defaulted. Adverse events were observed in 73.3% of patients, occurring in 74.8% of patients who were adherent (taking at least 80% of prescribed doses) and 59.1% of non-adherent individuals (P = 0.11). The impact of adverse events on outcome was modified by non-adherence; among adherent patients, the occurrence of any adverse reaction was associated with treatment cure (adjusted odds ratio 3.24, 95% confidence interval 1.56-6.70).


CONCLUSIONS
Adverse reactions occurred frequently in MDR-TB patients in Tomsk, Russia, but did not negatively impact treatment outcome. The occurrence of adverse reactions among adherent patients was associated with treatment cure.
Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. sshin@partners.org
S S
SS
Shin
A D
AD
Pasechnikov
I Y
IY
Gelmanova
G G
GG
Peremitin
A K
AK
Strelis
S
S
Mishustin
A
A
Barnashov
Y
Y
Karpeichik
Y G
YG
Andreev
V T
VT
Golubchikova
T P
TP
Tonkel
G V
GV
Yanova
A
A
Yedilbayev
M L
ML
Rich
J S
JS
Mukherjee
J J
JJ
Furin
S
S
Atwood
P E
PE
Farmer
S
S
Keshavjee
D000293:Adolescent; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D000995:Antitubercular Agents / Q000009:adverse effects*; D023801:Directly Observed Therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012426:Russia / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000453:epidemiology
D000995:Antitubercular Agents