Treatment-Associated Adverse Effects in Patients with Multidrug-Resistant Tuberculosis: A Study from Khyber Pakhtunkhwa

Abstract

Background: Pakistan ranks fourth among the 22 high-burden countries for multidrug-resistant tuberculosis (MDR-TB). The rising incidence of MDR-TB highlights the need for effective treatment programs, as the clinical management of MDR-TB involves prolonged multidrug regimens that frequently result in adverse events (AEs). Objective: This study aims to determine the frequency of treatment-related adverse events among patients enrolled in MDR-TB treatment. Methodology: We conducted a retrospective case series study involving patients enrolled for MDR-TB treatment from January 2020 to April 2022 at the Programmatic Management of Drug-Resistant TB (PMDT) unit of Lady Reading Hospital (LRH) in Peshawar, Pakistan. Patient data were recorded in an Electronic Nominal Record System (ENRS). Statistical analysis was performed using SPSS software, with subjective data assessed through the Chi-Square test and quantitative data analyzed using Student's t-test. Both univariate and multivariate regression models were employed to explore the relationship between medication-related adverse reactions and treatment outcomes, setting a significance threshold at p < 0.05. Results: The study included 411 MDR-TB patients undergoing treatment. Of these, 360 patients were analyzed, comprising 212 (51.6%) males and 148 (36%) females, predominantly aged between 15-44 and 45-64 years. The most frequently reported side effects were psychiatric symptoms (67%), gastrointestinal issues (58.5%), ototoxicity (49.5%), and arthralgia/arthritis (48.7%). Psychiatric symptoms affected 241 (67%) patients, with 91 (25.3%) experiencing major adverse events. In contrast, 150 (41.6%) cases of adverse events were classified as non-serious and managed through additional medications or dosage adjustments. Conclusion: Adverse events are common among MDR-TB patients treated at PMDT-LRH Peshawar. Younger patients and those with cavitary lung disease should be monitored closely for the development of adverse events to enhance patient safety and treatment efficacy.