Efficacy and safety of herbal medicines for prevention hepatotoxicity from anti-tuberculosis drug (anti-TB-DILI): A systematic review and meta-analysis of randomized controlled trials
Article Sidebar
Main Article Content
Abstract
Anti-tuberculosis drug-induced liver injury (anti-TB-DILI) is the most common adverse events necessitating therapy interruption. There is at present no standard regimen to prevent anti-TB-DILI. Therefore we performed a systematic review and meta-analysis to determine the efficacy and safety of herbal medicines for preventing anti-tuberculosis drug-induced liver injury (anti-TB-DILI) among tuberculosis patients. Methods: We searched published reports through the electronic databases including Pubmed, Embase, Scopus, Embase, Cochrane Central Register of Controlled Trials and databases in Thailand from inception to March 2022. The researchers selected randomized trials with a control group on the efficacy of herbs used for prevention of TB drug-induced liver injury among tuberculosis patients. The effect sizes were pooled using the random-effects model and expressed as relative risk (RR) or mean difference (MD) with 95% confidence intervals (CI). This study is registered with PROSPERO, number CRD42022353910. Result: The search identified a total of 2,507 related studies but 8 studies with 1,774 TB patients were included in this study. Time to follow-up duration were 2 to 24 weeks. The meta-analysis showed that Turmeric plus Tinospora cordifolia significantly reduced the incidence of anti-TB-DILI compared with placebo (RR: 0.05 (95%CI:0.01 to 0.19). While poly-herbal product and silymarin significantly reduced Aspartate aminotransferase (AST) (WMD = -21.80 (-27.56, -16.04) and 5.21 (-9.92, -0.51), respectively) Conclusion, Turmeric plus Tinospora cordifolia may provides the benefit with safe for preventing anti-TB DILI in TB patients, whereas poly-herbal product and Silymarin may provide benefit on reduction of AST which is a key enzyme to determine hepatotoxicity.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
In the case that some parts are used by others The author must Confirm that obtaining permission to use some of the original authors. And must attach evidence That the permission has been included
References
Adhvaryu, M. R., Reddy, N., & Vakharia, B. C. (2008). Prevention of hepatotoxicity due to anti tuberculosis treatment: a novel integrative approach. World J Gastroenterol, 14(30), 4753‐4762. doi: 10.3748/wjg.14.4753
Ataç, G., Sevim, T., Törün, T., Horzum, G., Gemci, I., Öngel, A., . . . Aksoy, E. (2001). The management of anti-tuberculosis drug-induced hepatotoxicity. The International Journal of Tuberculosis and Lung Disease, 5(1), 65-69.
Babalik, A., Arda, H., Bakirci, N., Agca, S., Oruc, K., Kiziltas, S., . . . Calisir, H. (2012). Management of and risk factors related to hepatotoxicity during tuberculosis treatment. Tuberk Toraks, 60(2), 136-144.
Baniasadi, S., Eftekhari, P., Tabarsi, P., Fahimi, F., Raoufy, M. R., Masjedi, M. R., & Velayati, A. A. (2010). Protective effect of N-acetylcysteine on antituberculosis drug-induced hepatotoxicity. Eur J Gastroenterol Hepatol, 22(10), 1235‐1238. doi: 10.1097/MEG.0b013e32833aa11b
Chaimani, A., Higgins, J. P., Mavridis, D., Spyridonos, P., & Salanti, G. (2013). Graphical tools for network meta-analysis in STATA. PLoS One, 8(10), e76654.
DerSimonian, R., & Laird, N. (1986). Meta-analysis in clinical trials Control Clin Trials. 1986, 177(10).
Dolin, P. J., Raviglione, M. C., & Kochi, A. (1993). A review of current epidemiological data and estimation of future tuberculosis incidence and mortality.
Døssing, M., Wilcke, J., Askgaard, D., & Nybo, B. (1996). Liver injury during antituberculosis treatment: an 11-year study. Tubercle and Lung Disease, 77(4), 335-340.
Eminzade, S., Uras, F., & Izzettin, F. V. (2008). Silymarin protects liver against toxic effects of anti-tuberculosis drugs in experimental animals. Nutrition & Metabolism, 5(1), 1-8.
Gu, J., Tang, S.-J., Tan, S.-Y., Wu, Q., Zhang, X., Liu, C.-X., . . . Gao, A.-P. (2015). An open-label, randomized and multi-center clinical trial to evaluate the efficacy of Silibinin in preventing drug-induced liver injury. International journal of clinical and experimental medicine, 8(3), 4320.
Gulati, K., Ray, A., & Vijayan, V. K. (2010). Assessment of protective role of polyherbal preparation, Livina, against anti-tubercular drug induced liver dysfunction. Indian J Exp Biol, 48(3), 318‐322.
Heo, E., Kim, D. K., Oh, S. H., Lee, J.-K., Park, J.-H., & Chung, H. S. (2017). Effect of prophylactic use of silymarin on anti-tuberculosis drugs induced hepatotoxicity. Tuberculosis and respiratory diseases, 80(3), 265-269.
Higgins, J. P., & Green, S. (2008). Cochrane handbook for systematic reviews of interventions. Chichester, England; Hoboken: NJ: Wiley-Blackwell.
Higgins, J. P., & Thompson, S. G. (2002). Quantifying heterogeneity in a meta‐analysis. Statistics in medicine, 21(11), 1539-1558.
Hutton, B., Salanti, G., Caldwell, D. M., Chaimani, A., Schmid, C. H., Cameron, C., . . . Jansen, J. P. (2015). The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med, 162(11), 777-784.
Kaona, F. A., Tuba, M., Siziya, S., & Sikaona, L. (2004). An assessment of factors contributing to treatment adherence and knowledge of TB transmission among patients on TB treatment. BMC Public Health, 4(1), 1-8.
Liu, Q., Garner, P., Wang, Y., Huang, B., & Smith, H. (2008). Drugs and herbs given to prevent hepatotoxicity of tuberculosis therapy: systematic review of ingredients and evaluation studies. BMC Public Health, 8(1), 1-8.
Luangchosiri, C., Thakkinstian, A., Chitphuk, S., Stitchantrakul, W., Petraksa, S., & Sobhonslidsuk, A. (2015). A double-blinded randomized controlled trial of silymarin for the prevention of antituberculosis drug-induced liver injury. BMC Complement Altern Med, 15, 334. doi: 10.1186/s12906-015-0861-7
Makhlouf, H. A., Helmy, A., Fawzy, E., El-Attar, M., & Rashed, H. A. G. (2008). A prospective study of antituberculous drug-induced hepatotoxicity in an area endemic for liver diseases. Hepatology international, 2(3), 353-360.
Marjani, M., Baghaei, P., Dizaji, M. K., Bayani, P. G., Fahimi, F., Tabarsi, P., & Velayati, A. A. (2016). Evaluation of hepatoprotective effect of silymarin among under treatment tuberculosis patients: A randomized clinical trial. Iranian journal of pharmaceutical research: IJPR, 15(1), 247.
Organization, W. H. (2020). World Health Organization Global Tuberculosis Report 2020. World Health Organization, 232.
Ramappa, V., & Aithal, G. P. (2013). Hepatotoxicity related to anti-tuberculosis drugs: mechanisms and management. Journal of clinical and experimental hepatology, 3(1), 37-49.
Schaberg, T. (1995). The dark side of antituberculosis therapy: adverse events involving liver function. European Respiratory Journal, 8(8), 1247-1249.
Tabarsi, P., Fahimi, F., Heidarzadeh, N., Haghgoo, R., Kazempour, M., Masjedi, M., & Velayati, A. A. (2014). The effect of Garcin® in preventing antiTB-induced hepatitis in newly diagnosed tuberculosis patients. Iranian journal of pharmaceutical research: IJPR, 13(Suppl), 169.
Tao, L., Qu, X., Zhang, Y., Song, Y., & Zhang, S.-x. (2019). Prophylactic therapy of silymarin (milk thistle) on antituberculosis drug-induced liver injury: a meta-analysis of randomized controlled trials. Canadian Journal of Gastroenterology and Hepatology, 2019.
Wang, P., Pradhan, K., Zhong, X.-b., & Ma, X. (2016). Isoniazid metabolism and hepatotoxicity. Acta pharmaceutica sinica B, 6(5), 384-392.
World Health Organization. (2017). World Health Organization: Global Tuberculosis Report: WHO Press Geneva.
Xia, Y. Y., Liu, F. Y., Wang, X. M., Yuan, Y. L., Chen, Y. X., Zhou, L., . . . Yang, L. (2010). Design of the anti-tuberculosis drugs induced adverse reactions in China National Tuberculosis Prevention and Control Scheme Study (ADACS). BMC Public Health, 10(1), 1-9.
Zhang, S., Pan, H., Peng, X., Lu, H., Fan, H., Zheng, X., . . . Wang, J. (2016). Preventive use of a hepatoprotectant against anti-tuberculosis drug-induced liver injury: a randomized controlled trial. J Gastroenterol Hepatol, 31(2), 409‐416. doi: 10.1111/jgh.13070