Impact of Pyrazinamide Usage on Serious Adverse Events in Elderly Tuberculosis

초록

Rationale: Pyrazinamide (PZA) in tuberculosis (TB) treatment, particularly in elderly patients, mayhave been associated with an increased risk of adverse effects. Some elderly TB opt for treatmentregimens excluding PZA due to these concerns. This study investigates whether PZA usage affectsthe occurrence of Serious Adverse Events (SAEs) within the first two months of TB treatment in theelderly population. Methods: A prospective cohort study was conducted from July 2019 to June2023, involving TB patients from 18 institutions. The study aimed to assess the impact of PZA onthe risk of SAEs during the initial two months of TB treatment in elderly patients. Results: Among the1,077 patients in the cohort, 457 were elderly individuals aged 65 or older. Of all 457 elderlypatients, PZA was used in 417 patients (91.2%) and 72 (15.8%) experienced SAEs within the firsttwo months. The mean age of the non-PZA group was older than that of the PZA group (79.08 ±7.18 vs 75.49 ± 7.18, p<0.001). The treatment success rate was significantly lower in the non-PZAgroup compared to the PZA group (67.5% vs 81.8%, p=0.029). Specifically, there was nodifference of the occurrence of SAEs between two groups (9.7% in the non-PZA group vs. 8.6% inthe PZA group, p=0.751). Logistic regression analysis showed that age was a significant risk factorfor SAEs within two months (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.05-1.13, p<0.001),but PZA was not (OR 0.91, 95% CI 0.36-2.27, p=0.841). Conclusion: In elderly TB patients, PZA didnot affect the occurrence of SAEs within the first two months of TB treatment. Thus, considering thepotential benefits, it could advisable to use PZA in the elderly TB.