Tuberculosis Clinical Trial
Official title:
Measurement of Drug Levels and Their Correlation With Hepatotoxicity During Antituberculosis Treatment
The purpose of this study is to evaluate plasma levels of hepatotoxic anti-tuberculous drugs (isoniazid, rifampicin, pyrazinamide plus significant metabolites) among patients on antituberculosis treatment (ATT) and compare the same among those who develop drug induced hepatitis on follow up versus those who do not.
Tuberculosis (TB) is a major health problem in both the developing and developed countries
because of its resurgence in the immunosuppressed patients. World Health Organization (WHO)
in 1993 declared tuberculosis to be a 'global emergency' with more than a third of the
world's population infected. Globally 8.9 million new cases of tuberculosis occur annually,
of which 1.8 million (20%) occur in India.
Short-course chemotherapy containing isoniazid (INH), rifampicin (RMP) and pyrazinamide
(PZA) has proved to be highly effective in the treatment of tuberculosis. One of its adverse
effects is hepatotoxicity. It is the most common side effect leading to interruption of
therapy. It is associated with mortality of 6-12% if these drugs are continued even after
the onset of symptoms. Risk of hepatotoxicity is increased when these drugs are combined.
The time interval between the start of anti-TB drugs and appearance of hepatotoxicity varies
from 3 to 135 days. In most cases hepatitis is evident within three months of start of
antituberculosis treatment (ATT).
The pathogenesis of drug-induced hepatotoxicity (DIH) is still not entirely clear for most
anti TB drugs including rifampicin. Hypersensitivity is a definite possibility Rifampicin
induced hepatitis has been postulated to occur as a part of systemic allergic reaction and,
due to unconjugated hyperbilirubinaemia as a result of competition with bilirubin for uptake
at hepatocyte plasma membrane. DIH caused by rifampicin occurs earlier as compared to
isoniazid. While a dose related toxicity may exist, a direct correlation between serum drug
levels and hepatotoxicity has not been well reported. Thus the clinical relevance of
therapeutic monitoring of serum rifampicin concentrations in managing DIH is still being
explored.
Present study done to observe serum rifampicin, isoniazid, pyrazinamide level in patients on
ATT and to compare it retrospectively between patients who develop drug induced hepatitis vs
those who do not.
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Observational Model: Case Control, Time Perspective: Prospective
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