Moxifloxacin concentration correlate with QTc interval in rifampicin-resistant tuberculosis patients on shorter treatment regimens

Tutik Kusmiati; Ni Made Mertaniasih; Johanes Nugroho Eko Putranto; Budi Suprapti; Nadya Luthfah; Soedarsono Soedarsono; Winariani Koesoemoprodjo; Aryani Prawita Sari

doi:10.1016/j.jctube.2022.100320

Moxifloxacin concentration correlate with QTc interval in rifampicin-resistant tuberculosis patients on shorter treatment regimens

J Clin Tuberc Other Mycobact Dis. 2022 Jun 6:28:100320. doi: 10.1016/j.jctube.2022.100320. eCollection 2022 Aug.

Authors

Affiliations

¹ Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Indonesia.
² Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia.
³ Laboratory of Tuberculosis, Institute of Tropical Disease, Universitas Airlangga. Surabaya, Indonesia.
⁴ Department of Medical Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia.
⁵ Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia.
⁶ Department of Clinical Pharmacy, Faculty of Pharmacy, Universitas Airlangga, Surabaya, East Java, Indonesia.

Abstract

Background: Drug-resistant tuberculosis (DR-TB) continues to be a global threat. Moxifloxacin is one of the components of the shorter treatment regimen which is suspected to increase the risk of QT prolongation, although it is also likely to be the most effective against DR-TB. A study to evaluate the correlation between the concentration of moxifloxacin and QTc interval in RR-TB patients who received shorter regimens is needed.

Methods: This was an observational study in 2 groups of RR-TB patients on shorter treatment regimens (intensive phase and continuation phase), contain moxifloxacin with body weight-adjusted dose. Blood samples were collected at 2 h after taking the 48th-hour dose and 1 h before taking the 72nd-hour dose.

Results: Forty-five RR-TB patients were included in this study. At 2 h after taking the 48th-hour dose, the mean of QTc interval in intensive phase and continuation phase was 444.38 ms vs. 467.94 ms, p = 0.026, while mean of moxifloxacin concentration in intensive phase and continuation phase was 4.3 µg/mL vs. 4.61 µg/mL, p = 0.686). At 1 h before taking the 72nd-hour dose, both moxifloxacin concentration and QTc interval in intensive phase and continuation showed no significant difference with p-value of 0.610 and 0.325, respectively. At 2 h after taking the 48th-dose, moxifloxacin concentration did not correlate with QTc interval, both in intensive phase (p = 0.576) and in continuation phase (p = 0.691). At 1 h before taking the 72nd-hour dose, moxifloxacin concentration also did not correlate with QTc interval in intensive phase (p = 0.531) and continuation phase (p = 0.209).

Conclusions: Our study found that moxifloxacin concentration did not correlate with QTc interval, which indicates the safe use of moxifloxacin on QTc interval. In addition to close monitoring of QTc interval, the clinicians should also consider other variables which potentially increase risk for QTc prolongation in DR-TB patients who received shorter treatment regimens.

Keywords: Drug-resistant tuberculosis; Moxifloxacin concentration; QTc interval; Shorter treatment regimen.