title: Hepatotoxicity from antituberculous therapy in the elderly: a systematic review.
abstract: BACKGROUND
  Elderly persons have the highest rates of tuberculosis (TB) in the United States compared to all other age groups. A systematic literature review was conducted to determine if older age was a risk factor for hepatotoxicity resulting from treatment with first-line drugs used to treat active (TB) and latent tuberculosis (LTBI).
  
  
  METHODS
  A systematic review of MEDLINE, Cochrane Controlled Trial Registry, CINAHL(®), and Science Citation Index Expanded (from 1970 to 2011) was performed to determine the risk of hepatotoxicity, comparing those over 60 with those under 60. A meta-analysis was performed using a random effects model along with log odds ratios and the chi-square test.
  
  
  RESULTS
  Thirty-eight studies (40,034 participants; 1208 cases of hepatotoxicity) met the selection criteria. For active TB, an overall mean effect of 0.277 (p = 0.024, 95% CI: 0.037-0.517) was observed, which is equivalent to an odds ratio of 1.32 (95% CI: 1.04-1.68). For LTBI, an overall mean effect of 1.42 (p < 0.001, 95% CI: 0.794-2.05) was observed, which translates to an odds ratio of 4.14 (95% CI: 2.21-7.74).
  
  
  CONCLUSIONS
  Our analysis revealed that patients older than 60 had significantly more risk of hepatotoxicity. These studies suggest that a gentler regimen of treatment for older individuals could benefit health outcomes in this population of TB patients and minimize risks to the public's health.
authors.affiliation: Southeastern National Tuberculosis Center, Department of Medicine, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA.
authors.forename: Jennifer D
authors.initials: JD
authors.lastname: Hosford
authors.affiliation: Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA; Department of Environmental and Global Health, University of Florida, Gainesville, FL, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: von Fricken
authors.affiliation: Southeastern National Tuberculosis Center, Department of Medicine, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Lauzardo
authors.affiliation: Department of Biostatistics, University of Florida, Gainesville, FL, USA.
authors.forename: Myron
authors.initials: M
authors.lastname: Chang
authors.affiliation: Department of Biostatistics, University of Florida, Gainesville, FL, USA.
authors.forename: Yunfeng
authors.initials: Y
authors.lastname: Dai
authors.affiliation: Biomedical and Health Information Services, University of Florida, Gainesville, FL, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Lyon
authors.affiliation: Department of Health Outcomes and Policy, University of Florida, Gainesville, FL, USA.
authors.forename: John
authors.initials: J
authors.lastname: Shuster
authors.affiliation: Southeastern National Tuberculosis Center, Department of Medicine, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA. Electronic address: Kevin.Fennelly@medicine.ufl.edu.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Fennelly
mesh_terms: D000367:Age Factors; D000368:Aged; D000995:Antitubercular Agents / Q000009:adverse effects* / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D006801:Humans; D055985:Latent Tuberculosis / Q000188:drug therapy; D012307:Risk Factors; D014376:Tuberculosis / Q000188:drug therapy
chemical_list: D000995:Antitubercular Agents
keywords: Aging; Antituberculous; Elderly; Hepatotoxicity; Latent tuberculosis; Systematic review; Therapy; Toxicity; Treatment; Tuberculosis