Abstract
The short treatment regimen (STR) achieves a >80% cure in rifampicin-resistant tuberculosis (RR-TB) patients. However, ototoxicity induced by the injectable is a concern. This is the first study to evaluate the replacement of injectables by linezolid in patients with audiometry abnormalities at baseline or during the treatment.
We conducted a retrospective cohort study of all RR-TB patients started on the STR between 2016 and June, 2019, in Niger. Patients underwent audiometry every 2 months in 2016 and every month since 2017.
Of 195 patients, 16.9% (33 out of 195) received linezolid from the start (n=17), or switched from injectables to linezolid during treatment (n=16), based on audiometry abnormalities. In 2016, two patients developed severe ototoxicity despite switching to linezolid. Since 2017, no patient developed severe hearing loss or complete deafness. Severe haematological toxicity was observed in 18.1% (six out of 33) of patients on linezolid, none of which was life threatening. The use of linezolid was associated with severe but manageable adverse events (hazard ratio 8.9, 95% CI 2.5–31.5; p=0.001). A total of 90.9% (30 out of 33) of patients on a linezolid-containing STR were cured, and none experienced treatment failure. Three died, but not due to adverse events.
Baseline and monthly audiometry monitoring and using linezolid after detection of hearing abnormalities appears effective to prevent severe ototoxicity, while keeping high treatment success and manageable adverse events.
Abstract
In patients with rifampicin-resistant tuberculosis and hearing loss a short treatment regimen with linezolid replacing the injectable was highly effective, adverse events were manageable, and switching early to linezolid prevented severe hearing loss. https://bit.ly/2Oz0KMc
Footnotes
Ethics approval: The study was approved by the Niger National Ethics Committee and the ITM Institutional Review Board, which waived the requirement to obtain informed consent
Author contributions: M.B. Souleymane, A. Piubello and T. Decroo designed the study, did the analysis, and wrote the first draft. All co-authors contributed to the interpretation of the findings, critically revised subsequent versions and approved the final version.
Conflict of interest: M.B. Souleymane has nothing to disclose.
Conflict of interest: A. Piubello has nothing to disclose.
Conflict of interest: I.M. Mamane-Lawan has nothing to disclose.
Conflict of interest: S. Hassane-Harouna has nothing to disclose.
Conflict of interest: M.M. Assao-Neino has nothing to disclose.
Conflict of interest: A. Soumana has nothing to disclose.
Conflict of interest: Z. Hamidou-Harouna has nothing to disclose.
Conflict of interest: A. Gagara-Issoufou has nothing to disclose.
Conflict of interest: N. Ortuño-Gutiérez has nothing to disclose.
Conflict of interest: A. Roggi has nothing to disclose.
Conflict of interest: V. Schwoebel has nothing to disclose.
Conflict of interest: S. Mamadou has nothing to disclose.
Conflict of interest: L. Lynen has nothing to disclose.
Conflict of interest: B. De Jong has nothing to disclose.
Conflict of interest: A. Van Deun has nothing to disclose.
Conflict of interest: T. Decroo has nothing to disclose.
- Received June 10, 2020.
- Accepted July 13, 2020.
- Copyright ©ERS 2021