Linezolid-Associated Neuropathy in Patients with MDR/XDR Tuberculosis in Shenzhen, China

Peize Zhang; Wei Li; Miaona Liu; Senlin Zhan; Hailin Zhang; Guofang Deng; Xiaoyou Chen

doi:10.2147/IDR.S365371

Linezolid-Associated Neuropathy in Patients with MDR/XDR Tuberculosis in Shenzhen, China

Infect Drug Resist. 2022 May 23:15:2617-2624. doi: 10.2147/IDR.S365371. eCollection 2022.

Authors

Peize Zhang^{1

2}, Wei Li³, Miaona Liu³, Senlin Zhan², Hailin Zhang², Guofang Deng², Xiaoyou Chen¹

Affiliations

¹ Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, People's Republic of China.
² Department of Pulmonary Medicine and Tuberculosis, The Third People's Hospital of Shenzhen, Shenzhen, Guangdong, People's Republic of China.
³ Department of Pharmacy, The Third People's Hospital of Shenzhen, Shenzhen, Guangdong, People's Republic of China.

Abstract

Objective: Linezolid is one of the key drugs for the treatment of multidrug-resistant/extensively drug-resistant tuberculosis (MDR/XDR-TB). We aimed to describe the incorporation of the Michigan Neuropathy Screening Instrument (MNSI) and serum trough concentration as screening tools for neurotoxicity in the management of MDR/XDR-TB patients receiving a linezolid-based treatment regimen in Shenzhen, China.

Methods: A total of 73 patients on a linezolid-containing anti-MDR/XDR-TB regimen were prospectively enrolled. The MNSI was used for peripheral neuropathy screening. Optic neuropathy was diagnosed by ophthalmologists. Serum trough concentration was recorded and its relationship with neuropathy analyzed.

Results: Of all patients, neuropathy was observed in 40% (29) during anti-TB treatment. Of these, 20 (69%) had peripheral neuritis, seven (24%) optic neuritis, and two (7%) both. Serum trough concentration >2 mg/L was observed in 17 (59%) patients with neuropathy and 13 (30%) patients without neuropathy. There was a significant statistical difference between the two groups (P=0.013). Time to onset of neuropathy from initiation of the linezolid-containing regimen was within 2 months for eight (28%) patients, 2-6 months for 18 (62%) patients, and >6 months for three (10%) patients. Sixteen (55%) patients were adjusted to a lower dose of 300 mg linezolid daily. Four (14%) patients had linezolid permanently removed from their regimen.

Conclusion: Neuropathy is a commonly reported adverse event associated with long-term use of linezolid. MNSI and serum trough-concentration monitoring can be adopted as simple screening tools for early detection of neuropathy to balance linezolid efficacy and tolerability.

Keywords: MDR/XDR-TB; MNSI; linezolid; neuropathy; serum trough concentration.

Grants and funding

This study was funded by the Yangfan Foundation (2018KYJJ003), Summit Plan for Foshan High-level Hospital Construction (No. FSSYKF-2020001), Project funded by Shenzhen Third People's Hospital (No. G2021023) and the Technology Project of Guangdong Province (2020B1111170014), which are government funding schemes for the research of tuberculosis treatment and control.