Linezolid-Associated Optic Neuropathy in Drug-Resistant Tuberculosis Patients in Mumbai, India.
BACKGROUND
Patients on linezolid-containing drug-resistant TB (DR-TB) regimen often develop adverse-events, particularly peripheral and optic neuropathy. Programmatic data and experiences of linezolid-associated optic neuropathy from high DR-TB burden settings are lacking. The study aimed to determine the frequency of and risk-factors associated with linezolid-associated optic neuropathy and document the experiences related to treatment/care of DR-TB patients on linezolid-containing regimens.


METHODS
This was a retrospective cohort study using routine clinical and laboratory data in Médecins Sans Frontières (MSF) HIV/DR-TB clinic in collaboration with Lilavati Hospital & Research Center, Mumbai, India. All DR-TB patients on linezolid-containing treatment regimens were included in the study and underwent routine evaluations for systemic and/or ocular complaints. Ophthalmological evaluation by a consultant ophthalmologist included visual-acuity screening, slit-lamp examination and dilated fundus examination.


RESULTS
During January 2013-April 2016, 86 of 136 patients (with/without HIV co-infection) initiated linezolid-containing DR-TB treatment. The median age of these 86 patients was 25 (20-35) years and 47% were males. 20 percent of them had HIV co-infection. Of 86, 24 (27.9%) had at least one episode of ocular complaints (the majority blurred-vision) and among them, five (5.8%) had optic neuropathy. Patients received appropriate treatment and improvements were observed. None of the demographic/clinical factors were associated with optic neuropathy in Poissons or multivariate binary logistic-regression models.


CONCLUSIONS
This is the first report focusing on optic neuropathy in a cohort of complex DR-TB patients, including patients co-infected with HIV, receiving linezolid-containing regimens. In our study, one out of four patients on linezolid had at least one episode of ocular complaints; therefore, systematic monitoring of patients by primary physicians/nurses, and access to specialized diagnostic-services by specialists are needed. As linezolid will be increasingly added to treatment regimens of DR-TB patients, programmes should allocate adequate resources for early diagnosis, prevention and management of this disabling adverse event.
Ophthalmology Department, Lilavati Hospital and Research Centre, Mumbai, India.
Salil
S
Mehta
Médecins Sans Frontières, Mumbai, India.
Mrinalini
M
Das
Médecins Sans Frontières, Mumbai, India.
Chinmay
C
Laxmeshwar
Médecins Sans Frontières, Mumbai, India.
Sylvie
S
Jonckheere
Médecins Sans Frontières, Mumbai, India.
Sein Sein
SS
Thi
Médecins Sans Frontières, Mumbai, India.|Médecins Sans Frontières, Operational Research Unit, Luxembourg city, Luxembourg.
Petros
P
Isaakidis
D000328:Adult; D000995:Antitubercular Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D000069349:Linezolid / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D009901:Optic Nerve Diseases / Q000139:chemically induced* / Q000453:epidemiology; D012189:Retrospective Studies; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000453:epidemiology; D055815:Young Adult
D000995:Antitubercular Agents; D000069349:Linezolid