Neuropsychiatric toxicity and cycloserine concentrations during treatment for multidrug-resistant tuberculosis.

Adult Antibiotics, Antitubercular / administration & dosage Cycloserine / administration & dosage Depression / chemically induced Female HIV Infections / drug therapy Humans Incidence Isoxazoles / adverse effects Male Middle Aged Oxazolidinones / adverse effects Peripheral Nervous System Diseases / chemically induced Prospective Studies Psychoses, Substance-Induced / epidemiology Risk Factors Tuberculosis, Multidrug-Resistant / drug therapy
Cycloserine Neuropathy Neuropsychiatric Pharmacokinetics Pyridoxine Terizidone

Journal

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases
ISSN: 1878-3511
Titre abrégé: Int J Infect Dis
Pays: Canada
ID NLM: 9610933

Informations de publication

Date de publication:
Apr 2021
Historique:
received: 23 11 2020
revised: 19 02 2021
accepted: 02 03 2021
pubmed: 9 3 2021
medline: 1 6 2021
entrez: 8 3 2021
Statut: ppublish

Résumé

Cycloserine, or its structural analogue terizidone, has been associated with neuropsychiatric toxicity (psychosis, depression, and neuropathy). Prospective clinical data on the incidence of and risk factors for neuropsychiatric toxicity in TB patients treated with cycloserine are limited. A prospective evaluation of neuropsychiatric toxicity was performed using validated screening tools in patients with multidrug-resistant tuberculosis treated with terizidone. Cox proportional hazard modelling was performed to explore the effects of clinical variables and measures of cycloserine pharmacokinetics in plasma. A total 144 participants were recruited: 86 were male and 58 were female; their median age was 35.7 years and 91 (63%) were HIV-infected. Fifty-five (38%) participants developed at least one neuropsychiatric event (30 cases per 100 person-months): 50 (35%) neuropathy, 14 (10%) depression, and 11 (8%) psychosis. Neuropathy was independently associated with cycloserine clearance ((adjusted hazard ratio 0.34 (aHR), P = 0.03)) and high-dose pyridoxine (200 mg vs 150 mg daily, aHR: 2.79, P = 0.01). A high incidence of early neuropsychiatric toxicity was observed in this cohort of patients treated with terizidone. Cycloserine clearance and higher doses of pyridoxine are associated with incident or worsening peripheral neuropathy.

Sections du résumé

BACKGROUND BACKGROUND
Cycloserine, or its structural analogue terizidone, has been associated with neuropsychiatric toxicity (psychosis, depression, and neuropathy). Prospective clinical data on the incidence of and risk factors for neuropsychiatric toxicity in TB patients treated with cycloserine are limited.
METHODS METHODS
A prospective evaluation of neuropsychiatric toxicity was performed using validated screening tools in patients with multidrug-resistant tuberculosis treated with terizidone. Cox proportional hazard modelling was performed to explore the effects of clinical variables and measures of cycloserine pharmacokinetics in plasma.
RESULTS RESULTS
A total 144 participants were recruited: 86 were male and 58 were female; their median age was 35.7 years and 91 (63%) were HIV-infected. Fifty-five (38%) participants developed at least one neuropsychiatric event (30 cases per 100 person-months): 50 (35%) neuropathy, 14 (10%) depression, and 11 (8%) psychosis. Neuropathy was independently associated with cycloserine clearance ((adjusted hazard ratio 0.34 (aHR), P = 0.03)) and high-dose pyridoxine (200 mg vs 150 mg daily, aHR: 2.79, P = 0.01).
CONCLUSIONS CONCLUSIONS
A high incidence of early neuropsychiatric toxicity was observed in this cohort of patients treated with terizidone. Cycloserine clearance and higher doses of pyridoxine are associated with incident or worsening peripheral neuropathy.

Identifiants

DOI: 10.1016/j.ijid.2021.03.001 PMID: 33684562 PMC: PMC8126338
pubmed: 33684562
pii: S1201-9712(21)00206-X
doi: 10.1016/j.ijid.2021.03.001
pmc: PMC8126338
mid: NIHMS1697305
pii:
doi:

Substances chimiques

Antibiotics, Antitubercular 0
Isoxazoles 0
Oxazolidinones 0
terizidone 1199LEX5N8
Cycloserine 95IK5KI84Z

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

688-694

Subventions

Organisme : NIAID NIH HHS
ID : R01 AI116155
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI068632
Pays : United States
Organisme : NIAID NIH HHS
ID : UM1 AI068632
Pays : United States
Organisme : NIAID NIH HHS
ID : UM1 AI068634
Pays : United States
Organisme : Wellcome Trust
ID : 206379/Z/17/Z
Pays : United Kingdom
Organisme : NIAID NIH HHS
ID : UM1 AI106701
Pays : United States
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : NIAID NIH HHS
ID : UM1 AI068636
Pays : United States

Informations de copyright

Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

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Auteurs

Richard Court (R)

Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa. Electronic address: richard.court@uct.ac.za.

Chad M Centner (CM)

Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa. Electronic address: chadc@nis.za.

Maxwell Chirehwa (M)

Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa. Electronic address: maxwell.chirehwa@uct.ac.za.

Lubbe Wiesner (L)

Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa. Electronic address: lubbe.wiesner@uct.ac.za.

Paolo Denti (P)

Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa. Electronic address: paolo.denti@uct.ac.za.

Nihal de Vries (N)

Brooklyn Chest Hospital, Cape Town, South Africa. Electronic address: Nihal.DeVries@westerncape.gov.za.

Joseph Harding (J)

DP Marais Hospital, Cape Town, South Africa. Electronic address: jojo@mweb.co.za.

Tawanda Gumbo (T)

Quantitative Preclinical and Clinical Sciences Department, Praedicare, Dallas, TX, USA. Electronic address: rozvi1@praedicarelabs.com.

Gary Maartens (G)

Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa), Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa. Electronic address: gary.maartens@uct.ac.za.

Helen McIlleron (H)

Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa), Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa. Electronic address: helen.mcilleron@uct.ac.za.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Neuropsychiatric toxicity and cycloserine...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antibactériens › Antituberculeux › Antibiotiques antituberculeux › Neuropsychiatric toxicity and cycloserine...
questionsmedicales.fr › Acides aminés, peptides et protéines › Acides aminés › Acides aminés neutres › Sérine › Cyclosérine › Neuropsychiatric toxicity and cycloserine...
questionsmedicales.fr › Comportement et mécanismes comportementaux › Émotions › Dépression › Neuropsychiatric toxicity and cycloserine...
questionsmedicales.fr › Maladies du système immunitaire › Déficits immunitaires › Infections à VIH › Neuropsychiatric toxicity and cycloserine...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Neuropsychiatric toxicity and cycloserine...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Morbidité › Incidence › Neuropsychiatric toxicity and cycloserine...
questionsmedicales.fr › Composés hétérocycliques › Composés hétéromonocycliques › Azoles › Isoxazoles › Neuropsychiatric toxicity and cycloserine...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Neuropsychiatric toxicity and cycloserine...
questionsmedicales.fr › Composés hétérocycliques › Composés hétéromonocycliques › Azoles › Oxazoles › Oxazolidinones › Neuropsychiatric toxicity and cycloserine...
questionsmedicales.fr › Maladies du système nerveux › Maladies neuromusculaires › Neuropathies périphériques › Neuropsychiatric toxicity and cycloserine...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Neuropsychiatric toxicity and cycloserine...
questionsmedicales.fr › Troubles mentaux › Troubles liés à une substance › Psychoses toxiques › Neuropsychiatric toxicity and cycloserine...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Facteurs de risque › Neuropsychiatric toxicity and cycloserine...
questionsmedicales.fr › Infection › Infections bactériennes et mycoses › Infections bactériennes › Infections bactériennes à Gram positif › Infections à Actinomycetales › Infections à Mycobacterium › Tuberculose › Tuberculose multirésistante › Neuropsychiatric toxicity and cycloserine...