M Cevik, A Sturdy, A E Maraolo, B G J Dekkers, O W Akkerman, S H Gillespie, J W C Alffenaar
{"title":"糖尿病对结核病药物代谢动力学影响的系统回顾。","authors":"M Cevik, A Sturdy, A E Maraolo, B G J Dekkers, O W Akkerman, S H Gillespie, J W C Alffenaar","doi":"10.5588/ijtld.23.0507","DOIUrl":null,"url":null,"abstract":"<p><p><sec><title>OBJECTIVES</title>The coexistence of TB and diabetes mellitus (DM) (TB-DM) is associated with an increased risk of treatment failure, death, delayed culture conversion, and drug resistance. Because plasma concentrations may influence clinical outcomes, we evaluated the evidence on the pharmacokinetic (PK) of TB drugs in individuals with DM to guide management.</sec><sec><title>METHODS</title>We performed a systematic review and meta-analysis through searches of major databases from 1946 to 6 July 2023. PROSPERO (CRD42022323566).</sec><sec><title>RESULTS</title>Of 4,173 potentially relevant articles, we identified 16 studies assessing rifampicin (RIF) PK, 9 on isoniazid (INH), 8 on pyrazinamide (PZA), and 3 on ethambutol (EMB). Two studies reported on second-line anti-TB drugs. According to our meta-analysis, RIF time to maximum concentration (T<sub>max</sub>) was significantly prolonged in patients with DM compared with non-DM patients. We found no significant differences for RIF C<sub>max</sub>, area under the curve (AUC) 0-24 or drug concentration at 2 h (C2h), INH C2h, PZA C2h, PZA T<sub>max</sub>, and EMB T<sub>max</sub>. Although RIF C2h was slightly reduced in patients with TB-DM, this finding was not statistically significant.</sec><sec><title>CONCLUSIONS</title>This review comprehensively examines the impact of DM on the PK of TB drugs. We observed significant heterogeneity among the studies. Given the association between lower plasma concentrations and poor clinical outcomes among patients with DM, we recommend a higher dose limit to compensate for the larger body weight of patients with DM.</sec>.</p>","PeriodicalId":14411,"journal":{"name":"International Journal of Tuberculosis and Lung Disease","volume":null,"pages":null},"PeriodicalIF":3.4000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A systematic review on the effect of diabetes mellitus on the pharmacokinetics of TB drugs.\",\"authors\":\"M Cevik, A Sturdy, A E Maraolo, B G J Dekkers, O W Akkerman, S H Gillespie, J W C Alffenaar\",\"doi\":\"10.5588/ijtld.23.0507\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><sec><title>OBJECTIVES</title>The coexistence of TB and diabetes mellitus (DM) (TB-DM) is associated with an increased risk of treatment failure, death, delayed culture conversion, and drug resistance. Because plasma concentrations may influence clinical outcomes, we evaluated the evidence on the pharmacokinetic (PK) of TB drugs in individuals with DM to guide management.</sec><sec><title>METHODS</title>We performed a systematic review and meta-analysis through searches of major databases from 1946 to 6 July 2023. PROSPERO (CRD42022323566).</sec><sec><title>RESULTS</title>Of 4,173 potentially relevant articles, we identified 16 studies assessing rifampicin (RIF) PK, 9 on isoniazid (INH), 8 on pyrazinamide (PZA), and 3 on ethambutol (EMB). Two studies reported on second-line anti-TB drugs. According to our meta-analysis, RIF time to maximum concentration (T<sub>max</sub>) was significantly prolonged in patients with DM compared with non-DM patients. We found no significant differences for RIF C<sub>max</sub>, area under the curve (AUC) 0-24 or drug concentration at 2 h (C2h), INH C2h, PZA C2h, PZA T<sub>max</sub>, and EMB T<sub>max</sub>. Although RIF C2h was slightly reduced in patients with TB-DM, this finding was not statistically significant.</sec><sec><title>CONCLUSIONS</title>This review comprehensively examines the impact of DM on the PK of TB drugs. We observed significant heterogeneity among the studies. Given the association between lower plasma concentrations and poor clinical outcomes among patients with DM, we recommend a higher dose limit to compensate for the larger body weight of patients with DM.</sec>.</p>\",\"PeriodicalId\":14411,\"journal\":{\"name\":\"International Journal of Tuberculosis and Lung Disease\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Tuberculosis and Lung Disease\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5588/ijtld.23.0507\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Tuberculosis and Lung Disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5588/ijtld.23.0507","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
A systematic review on the effect of diabetes mellitus on the pharmacokinetics of TB drugs.
OBJECTIVESThe coexistence of TB and diabetes mellitus (DM) (TB-DM) is associated with an increased risk of treatment failure, death, delayed culture conversion, and drug resistance. Because plasma concentrations may influence clinical outcomes, we evaluated the evidence on the pharmacokinetic (PK) of TB drugs in individuals with DM to guide management.METHODSWe performed a systematic review and meta-analysis through searches of major databases from 1946 to 6 July 2023. PROSPERO (CRD42022323566).RESULTSOf 4,173 potentially relevant articles, we identified 16 studies assessing rifampicin (RIF) PK, 9 on isoniazid (INH), 8 on pyrazinamide (PZA), and 3 on ethambutol (EMB). Two studies reported on second-line anti-TB drugs. According to our meta-analysis, RIF time to maximum concentration (Tmax) was significantly prolonged in patients with DM compared with non-DM patients. We found no significant differences for RIF Cmax, area under the curve (AUC) 0-24 or drug concentration at 2 h (C2h), INH C2h, PZA C2h, PZA Tmax, and EMB Tmax. Although RIF C2h was slightly reduced in patients with TB-DM, this finding was not statistically significant.CONCLUSIONSThis review comprehensively examines the impact of DM on the PK of TB drugs. We observed significant heterogeneity among the studies. Given the association between lower plasma concentrations and poor clinical outcomes among patients with DM, we recommend a higher dose limit to compensate for the larger body weight of patients with DM..
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The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.
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