title: Efficacy, safety and tolerability of linezolid containing regimens in treating MDR-TB and XDR-TB: systematic review and meta-analysis.
abstract: Linezolid is used off-label to treat multidrug-resistant tuberculosis (MDR-TB) in absence of systematic evidence. We performed a systematic review and meta-analysis on efficacy, safety and tolerability of linezolid-containing regimes based on individual data analysis. 12 studies (11 countries from three continents) reporting complete information on safety, tolerability, efficacy of linezolid-containing regimes in treating MDR-TB cases were identified based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analysis was performed using the individual data of 121 patients with a definite treatment outcome (cure, completion, death or failure). Most MDR-TB cases achieved sputum smear (86 (92.5%) out of 93) and culture (100 (93.5%) out of 107) conversion after treatment with individualised regimens containing linezolid (median (inter-quartile range) times for smear and culture conversions were 43.5 (21-90) and 61 (29-119) days, respectively) and 99 (81.8%) out of 121 patients were successfully treated. No significant differences were detected in the subgroup efficacy analysis (daily linezolid dosage ≤ 600 mg versus >600 mg). Adverse events were observed in 63 (58.9%) out of 107 patients, of which 54 (68.4%) out of 79 were major adverse events that included anaemia (38.1%), peripheral neuropathy (47.1%), gastro-intestinal disorders (16.7%), optic neuritis (13.2%) and thrombocytopenia (11.8%). The proportion of adverse events was significantly higher when the linezolid daily dosage exceeded 600 mg. The study results suggest an excellent efficacy but also the necessity of caution in the prescription of linezolid.
authors.affiliation: Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari, Sassari, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sotgiu
authors.forename: Rosella
authors.initials: R
authors.lastname: Centis
authors.forename: Lia
authors.initials: L
authors.lastname: D'Ambrosio
authors.forename: Jan-William C
authors.initials: JW
authors.lastname: Alffenaar
authors.forename: Holly A
authors.initials: HA
authors.lastname: Anger
authors.forename: Jose A
authors.initials: JA
authors.lastname: Caminero
authors.forename: Paolo
authors.initials: P
authors.lastname: Castiglia
authors.forename: Saverio
authors.initials: S
authors.lastname: De Lorenzo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ferrara
authors.forename: Won-Jung
authors.initials: WJ
authors.lastname: Koh
authors.forename: Giesela F
authors.initials: GF
authors.lastname: Schecter
authors.forename: Tae S
authors.initials: TS
authors.lastname: Shim
authors.forename: Rupak
authors.initials: R
authors.lastname: Singla
authors.forename: Alena
authors.initials: A
authors.lastname: Skrahina
authors.forename: Antonio
authors.initials: A
authors.lastname: Spanevello
authors.forename: Zarir F
authors.initials: ZF
authors.lastname: Udwadia
authors.forename: Miquel
authors.initials: M
authors.lastname: Villar
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Zampogna
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Zellweger
authors.forename: Alimuddin
authors.initials: A
authors.lastname: Zumla
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Migliori
mesh_terms: D000081:Acetamides / Q000494:pharmacology*; D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D000069349:Linezolid; D008297:Male; D008875:Middle Aged; D023303:Oxazolidinones / Q000494:pharmacology*; D061214:Patient Safety; D013183:Sputum / Q000378:metabolism; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*
chemical_list: D000081:Acetamides; D000995:Antitubercular Agents; D023303:Oxazolidinones; D000069349:Linezolid