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Meta-Analysis
. 2023 Nov 14;13(1):19880.
doi: 10.1038/s41598-023-46565-3.

Systematic review and network meta-analysis of efficacy and safety of interventions for preventing anti-tuberculosis drug induced liver injury

Pattaraporn Akkahadsee  1 , Ratree Sawangjit  2 , Panumart Phumart  3 , Nathorn Chaiyakunapruk  4   5 , Duangkamon Sakloetsakun  6
Affiliations
Meta-Analysis

Systematic review and network meta-analysis of efficacy and safety of interventions for preventing anti-tuberculosis drug induced liver injury

Pattaraporn Akkahadsee et al. Sci Rep. .

Abstract

Anti-tuberculosis drug induced liver injury (Anti-TB DILI) is the most common adverse events (AEs) necessitating therapy interruption but there is no preventing regimen. This study aimed to examine the efficacy and safety of herbs/alternative medicines for preventing anti-TB DILI. Relevant articles were identified through a systematic search in 5 international databases from inception till March 2022. All randomized controlled trials (RCT) assessing the effects of herbal or alternative medicines against anti-TB DILI were included. The network meta-analysis (NMA) was used to synthesize the evidence for preventing hepatotoxicity using a random-effects model. A total of 3423 patients from 14 RCTs were included. The NMA indicated that supplementation of Turmeric plus Tinospora cordifolia (RR 0.07; 95% CI 0.02 to 0.28), and N-acetyl cysteine (NAC) (RR 0.09; 95% CI 0.01 to 0.75) significantly reduced the incidence of anti-TB DILI compared with placebo. In addition, poly herbal product significantly reduced alkaline phosphatase (ALP) (MD - 21.80; 95% CI - 33.80 to - 9.80) and total bilirubin (Tbil) compared with placebo (MD - 0.51; 95% CI - 0.76 to - 0.26). There was no statistically significant difference in the occurrence of AEs in any intervention. In conclusion, Turmeric plus Tinospora cordifolia, NAC and poly-herbal product may provide benefit for preventing anti-TB DILI in TB patients. However, these findings are based on a small number of studies. Additional studies are warranted to confirm the findings.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flow diagram of study indentification and selection.
Figure 2
Figure 2
Network map for the occurrence of anti-TB-DILI (A) and for changes of liver function test (B).
Figure 3
Figure 3
Rankings of SUCRA for efficacy to prevent hepatotoxicity from tuberculosis drugs.
Figure 4
Figure 4
Subgroup analysis at week 4.
See this image and copyright information in PMC

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