Objective: To systematically evaluate the incidence of liver injury in multi-drug resistant tuberculosis (MDR-TB) patients with the treatment of second-line anti-TB drugs.
Methods: Medline (January 1, 1966 to March 1, 2014), Embase (January 1, 1974 to March 1, 2014) and the Cochrane library (January 1, 1993 to March 1, 2014) with four Chinese databases including VIP (January 1, 1989 to March 1, 2014), CBMDisc (January 1, 1978 to March 1, 2014), CNKI (January 1, 1994 to March 1, 2014)and Wanfang (January 1, 1998 to March 1, 2014), were systematically searched with the keywords including "Tuberculosis", "multidrug-resistant", "MDR-TB", "side effect", "adverse", "safety" and "tolerability" for the follow-up studies of MDR-TB patients with liver injury during the treatment of second-line anti-TB drugs. The relevant information was extracted and the data were analyzed using the random-effects model. Subgroup and sensitivity analyses were performed based on the diagnostic criteria, study population, study design, history of anti-TB treatment and treatment length.
Results: A total of 26 articles with 3 875 MDR-TB patients were included, of which 373 patients developed liver injury, and the weighed combined incidence of liver injury was 7.7%(95%CI:5.5%-10.8%). There was some heterogeneity among the studies. Subgroup analyses showed that the incidence of liver injury was higher in groups with treatment length ≥ 18 months and non-Asian populations, but there was no significant difference between the groups (P>0.05). Among the 26 articles, only nine of them reported the diagnostic criteria of liver injury, while the criteria were not uniform.
Conclusion: The incidence of liver injury during the treatment of second-line anti-TB drug in MDR-TB patients was high, and the diagnostic criteria were not uniform. We should pay attention to the prevention and treatment of liver injury, and develop standard diagnostic criteria for it.