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.
Shin
S S
SS
Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. sshin@partners.org
Pasechnikov
A D
AD
Gelmanova
I Y
IY
Peremitin
G G
GG
Strelis
A K
AK
Mishustin
S
S
Barnashov
A
A
Karpeichik
Y
Y
Andreev
Y G
YG
Golubchikova
V T
VT
Tonkel
T P
TP
Yanova
G V
GV
Yedilbayev
A
A
Rich
M L
ML
Mukherjee
J S
JS
Furin
J J
JJ
Atwood
S
S
Farmer
P E
PE
Keshavjee
S
S
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