Meta-analysis reveals multidrug-resistant TB treatment safe in pregnancy

Linezolid successfully treated pregnant patients with multidrug-resistant tuberculosis, with most patients experiencing favorable pregnancy outcomes, according to a meta-analysis published in JAMA Network Open.

“This is the first comprehensive review of treatment outcomes for multidrug-resistant tuberculosis in pregnant women, who remain one of the most vulnerable groups among the half a million people living with the disease globally,” Kefyalew Addis Alene, PhD, MPH, BSc, a senior research fellow at Curtin University in Bentley, Australia, said in a press release.

Alene and colleagues systematically reviewed databases from inception to Aug. 31, 2021, for studies that reported treatment outcomes in pregnant patients with multidrug-resistant tuberculosis (MDR-TB). In the 10 eligible studies — most of which were determined to be low- or medium-quality — the researchers evaluated the incidence of certain treatment outcomes and pregnancy-related adverse outcomes.

Among 275 patients, the pooled estimate for treatment success was 72.5% (95% CI, 63.3%-81%).

Eight studies included information on the type of drug used, with four studies reporting linezolid regimens. In these studies, the median success rate of linezolid was 20.1%. Individual study success rates were higher when a greater proportion of patients used linezolid regimens vs. a smaller proportion of patients (85% vs. 65.6%; OR = 1.22; 95% CI, 1.05-1.42).

Additionally, pooled estimates were 6.8% (95% CI, 2.6%-12.4%) for death, 18.4% (95% CI, 13.1%-24.2%) for loss to follow-up and 0.6% (95% CI, 0%-2.9%) for treatment failure.

Analyses of treatment outcomes revealed that 54.7% (95% CI, 43.5%-65.4%) of patients had at least one adverse event. The most common adverse event was impaired liver function (30.4%), followed by impaired kidney function (14.9%), hypokalemia (11.9%), hearing loss (11.8%), gastrointestinal disorders (11.8%), psychiatric disorders (9.1%) and anemia (8.9%).

The pooled estimate for favorable pregnancy outcomes was 73.2% (95% CI, 49.4%-92.1%), with the most common pregnancy-related adverse events being preterm birth (9.5%; 95% CI, 0%-29%), pregnancy loss (6%; 95% CI, 1.3%-12.9%), low birth weight (3.9%; 95% CI, 0%-18.7%) and stillbirth (1.9%; 95% CI, 0.1%-5.1%).

“This study shows we need to start the treatment as soon as possible during pregnancy,” Alene said in the release. “However, further research on the use of linezolid in pregnancy is needed because long-term use can increase the risk of gastrointestinal disorders, ototoxicity and psychiatric disorders.”

References:

• Alene KA, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.16527.
• Study finds TB treatment during pregnancy is safe for mum and baby. https://www.eurekalert.org/news-releases/956726. Published June 21, 2022. Accessed July 5, 2022.