TITLE:
Anti-Tuberculosis Drug Induced Liver Injury and Ursodeoxycholic Acid
AUTHORS:
Susanne M. Lang, Emad Al-Nemnem, Helmut Schiffl
KEYWORDS:
Ursodeoxycholic Acid, Hepatotoxicity, Rifampicin, Isoniazid, Pyrazinamide, Tuberculosis
JOURNAL NAME:
Journal of Tuberculosis Research,
Vol.8 No.2,
June
29,
2020
ABSTRACT: Hepatotoxicity induced by standard anti-tuberculosis drugs (isoniazid,
rifampicin, pyrazinamide) can result in significant morbidity and, rarely, even
mortality. This major adverse side-effect of anti-tuberculosis treatment has a
negative impact on patient adherence and patient outcomes as well as on
tuberculosis control. Early recognition and prompt withdrawal of the offending drugs are the most critical interventions in the
management of anti-tuberculosis drug-induced
liver injury. No drug or herbal extract has been shown until recently to
prevent or reverse anti-tuberculosis drug-induced hepatotoxicity. Ursodeoxycholic acid is the only FDA approved drug for the treatment of
primary biliary cholangitis and has also been successfully
used in various cholestatic liver diseases.
Although still experimental, recent controlled clinical studies suggested
that oral administration of ursodeoxycholic acid may prevent the onset of
anti-tuberculosis drug-induced liver injury and accelerate the recovery of liver injury. These clinical data are
supported by experimental models of anti-tuberculosis drug-induced
hepatotoxicity. There is an urgent need for further randomized clinical trials
to document the promising hepatoprotective properties of ursodeoxycholic acid.