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Infectious Medicine 2022, 1(3): 154-162 https://doi.org/10.1016/j.imj.2022.07.003
Original Article | Open Access | Issue | Published: 10 August 2022

Hepatoprotective drugs for prevention of liver injury resulting from anti-tuberculosis treatment: A meta-analysis of cohort studies

Show Author's Information Dong Wangb,1,  Xiao-ling Caia,1,  Xu Lind,  Jing Zhenga,  Yun-li Wuc( ),  Xian-e Penga,c( )
Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, China
Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, Fuzhou, China
Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
Department of Respiratory and Critical Care Medicine, Fuzhou Pulmonary Hospital of Fujian, Educational Hospital of Fujian Medical University, Fuzhou, China

1 These authors contributed equally to this work.

Keywords:
Tuberculosis, Meta-analysis, Hepatoprotective drug, Liver injury
Cite this article:
Wang D, Cai X-l, Lin X, et al. Hepatoprotective drugs for prevention of liver injury resulting from anti-tuberculosis treatment: A meta-analysis of cohort studies. Infectious Medicine, 2022, 1(3): 154-162. https://doi.org/10.1016/j.imj.2022.07.003
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Abstract Full text Electronic supplementary material About this article
Background

The incidence of liver injury caused by anti-tuberculous (TB) drugs is very high. However, owing to a lack of sufficient evidence, preventive use of hepatoprotective drugs is not yet recommended. Therefore, we aimed to assess the protective effect of hepatoprotective drugs for anti-TB drug-induced liver injury.

Methods

We conducted a literature search in China Biology Medicine disc, China National Knowledge Infrastructure, WanFang, Chinese Scientific and Technological Journal, PubMed, Cochrane Library, Web of Science, and Embase. We performed meta-analysis using R 4.0 and Review Manager 5.3 software.

Results

A total of 18 studies involving 3589 patients from 2 groups were included. Use of hepatoprotective drugs contributed to a lower incidence of liver injury as compared with conventional anti-TB treatment alone (relative risk [RR] = 0.39, 95% confidence interval [CI]: 0.28–0.53, p < 0.001). In subgroup analysis, significant protective effects were noted for mild liver injury (RR = 0.30, 95% CI 0.15–0.58), moderate (or severe) liver injury (RR = 0.35, 95% CI 0.19–0.65), and liver injury within 2–4 weeks (RR = 0.37, 95% CI 0.19–0.71). We also found a statistically significant difference in the incidence of drug withdrawal (RR = 0.58, 95% CI 0.34–0.97, p = 0.040).

Conclusions

Our results demonstrate that hepatoprotective drugs are effective in preventing liver injury in patients receiving anti-TB treatment, to some extent.


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Abstract
Full text
Outline
Electronic supplementary material
About this article

Hepatoprotective drugs for prevention of liver injury resulting from anti-tuberculosis treatment: A meta-analysis of cohort studies

Show Author's information Dong Wangb,1, Xiao-ling Caia,1, Xu Lind, Jing Zhenga, Yun-li Wuc( ), Xian-e Penga,c( )
Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou, China
Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, Fuzhou, China
Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
Department of Respiratory and Critical Care Medicine, Fuzhou Pulmonary Hospital of Fujian, Educational Hospital of Fujian Medical University, Fuzhou, China

1 These authors contributed equally to this work.

Abstract

Background

The incidence of liver injury caused by anti-tuberculous (TB) drugs is very high. However, owing to a lack of sufficient evidence, preventive use of hepatoprotective drugs is not yet recommended. Therefore, we aimed to assess the protective effect of hepatoprotective drugs for anti-TB drug-induced liver injury.

Methods

We conducted a literature search in China Biology Medicine disc, China National Knowledge Infrastructure, WanFang, Chinese Scientific and Technological Journal, PubMed, Cochrane Library, Web of Science, and Embase. We performed meta-analysis using R 4.0 and Review Manager 5.3 software.

Results

A total of 18 studies involving 3589 patients from 2 groups were included. Use of hepatoprotective drugs contributed to a lower incidence of liver injury as compared with conventional anti-TB treatment alone (relative risk [RR] = 0.39, 95% confidence interval [CI]: 0.28–0.53, p < 0.001). In subgroup analysis, significant protective effects were noted for mild liver injury (RR = 0.30, 95% CI 0.15–0.58), moderate (or severe) liver injury (RR = 0.35, 95% CI 0.19–0.65), and liver injury within 2–4 weeks (RR = 0.37, 95% CI 0.19–0.71). We also found a statistically significant difference in the incidence of drug withdrawal (RR = 0.58, 95% CI 0.34–0.97, p = 0.040).

Conclusions

Our results demonstrate that hepatoprotective drugs are effective in preventing liver injury in patients receiving anti-TB treatment, to some extent.

Keywords: Tuberculosis, Meta-analysis, Hepatoprotective drug, Liver injury

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Publication history

Received: 18 April 2022
Revised: 29 June 2022
Accepted: 22 July 2022
Published: 10 August 2022
Issue date: September 2022

Copyright

© 2022 The Authors. Published by Elsevier Ltd on behalf of Tsinghua University Press.

Acknowledgements

We thank Jing-Ru Huang of Fujian University of Traditional Chinese Medicine for helping us the data entry and checking. We thank the 2 referees and Editor for their many constructive and insightful comments that have led to significant improvements in the article.

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This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

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