The Role of Pyridoxine in the Prevention and Treatment of Neuropathy and Neurotoxicity Associated with Rifampicin-Resistant Tuberculosis Treatment Regimens: A Topic Review
Rifampicin-resistant tuberculosis (RR-TB) is a
global public health problem caused by mycobacterium tuberculosis resistant to
Rifampicin. Drug-induced peripheral neuropathy and neurotoxicity are well-known
adverse effects of treatment regimens that cause significant morbidity.
Pyridoxine is often added to treatment regimens for the prevention and/or
treatment of these side effects. The basis and effectiveness of this practice
are unclear. We conducted a systematic review to evaluate the effectiveness of
pyridoxine in preventing and/or treating neuropathy and neurotoxicity
associated with RR-TB treatment. We included studies with patients with RR-TB
who experienced neuropathy or neurotoxicity attributed to RR-TB regimens and
were given pyridoxine. Our findings showed contradicting evidence on the use of
pyridoxine for preventing or treating neurotoxicity due to cycloserine in the
treatment of RR-TB. Moreover, pyridoxine did not have a protective effect
against neuropathy and/or neurotoxicity caused by other RR-TB regimens that do
not contain isoniazid. In conclusion, we found that withdrawing or withholding
medications such as linezolid, cycloserine, thioamides, fluoroquinolones, and
ethambutol, implicated in causing neuropathy or neurotoxicity was more
effective than using pyridoxine to stop the progression of symptoms, and in
some instances, led to their reversal over time.
References
[1]
W.H.O. (2019) The Global TB Report 2019. World Health Organization, Geneva. https://apps.who.int/iris/bitstream/handle/10665/329368/9789241565714-eng.pdf
[2]
Ben Amor, Y., Nemser, B., Singh, A., Sankin, A. and Schluger, N. (2008) Underreported Threat of Multidrug-Resistant Tuberculosis in Africa. Emerging Infectious Diseases, 14, 1345-1352. https://doi.org/10.3201/eid1409.061524
[3]
Gandhi, N.R., et al. (2012) Risk Factors for Mortality among MDR- and XDR-TB Patients in a High HIV Prevalence Setting. The International Journal of Tuberculosis and Lung Disease, 16, 90-97. https://doi.org/10.5588/ijtld.11.0153
[4]
Molla, K.A., Reta, M.A. and Ayene, Y.Y. (2022) Prevalence of Multidrug-Resistant Tuberculosis in East Africa: A Systematic Review and Meta-Analysis. PLOS ONE, 17, e0270272. https://doi.org/10.1371/journal.pone.0270272
[5]
Ou, Z.-J., et al. (2021) Trends in Burden of Multidrug-Resistant Tuberculosis in Countries, Regions, and Worldwide from 1990 to 2017: Results from the Global Burden of Disease Study. Infectious Diseases of Poverty, 10, 24. https://doi.org/10.1186/s40249-021-00803-w
[6]
W.H.O. (2018) Companion Handbook to the WHO Guidelines for the Programmatic Management of Drug-Resistant Tuberculosis.
[7]
W.H.O. (2019) ShORRT (Short, All-Oral Regimens for Rifampicin-Resistant Tuberculosis). https://www.who.int/tdr/research/tb_hiv/ShORRT-Generic-protocol.pdf
[8]
Sutton, S., Magagnoli, J. and Hardin, J.W. (2016) Impact of Pill Burden on Adherence, Risk of Hospitalization, and Viral Suppression in Patients with HIV Infection and AIDS Receiving Antiretroviral Therapy. Pharmacotherapy, 36, 385-401. https://doi.org/10.1002/phar.1728
[9]
Mohd, S.N.A., et al. (2018) A Longitudinal Analysis of Daily Pill Burden and Likelihood of Optimal Adherence to Antiretroviral Therapy among People Living with HIV Who Use Drugs. Journal of Addiction Medicine, 12, 308-314. https://doi.org/10.1097/ADM.0000000000000403
[10]
MSF (2017) Out of Step: TB Policies in 29 Countries, 3rd Ed. https://msfaccess.org/out-step-tb-policies-29-countries-3rd-ed
[11]
Mafukidze, A.T., Calnan, M. and Furin, J. (2015) Peripheral Neuropathy in Persons with Tuberculosis. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 2, 5-11. https://doi.org/10.1016/j.jctube.2015.11.002
[12]
Ebrahimi, F., Farzaei, M.H., Bahramsoltani, R., Heydari, M., Naderinia, K. and Rahimi, R. (2019) Plant-Derived Medicines for Neuropathies: A Comprehensive Review of Clinical Evidence. Reviews in the Neurosciences, 30, 671-684. https://doi.org/10.1515/revneuro-2018-0097
[13]
Hammi, C. and Yeung, B. (2017) Neuropathy. StatPearls Publishing, Treasure Island. https://www.ncbi.nlm.nih.gov/books/NBK542220/
Serap, B. (2022) Ch. 9. Neurotoxicity, Types, Clinical Manifestations, Diagnosis and Treatment. In: Suna, S., Ed., Neurotoxicity, IntechOpen, Rijeka, 489-500.
[16]
National Research Council (US) Committee on Neurotoxicology and Models for Assessing Risk (1992) Introduction: Defining the Problem of Neurotoxicity. In: Environmental Neurotoxicology, National Academies Press (US), Washington, DC. https://www.ncbi.nlm.nih.gov/books/NBK234243/
Prasad, R., Singh, A. and Gupta, N. (2019) Adverse Drug Reactions in Tuberculosis and Management. Indian Journal of Tuberculosis, 66, 520-532. https://doi.org/10.1016/j.ijtb.2019.11.005
[19]
Parra, M., Stahl, S. and Hellmann, H. (2018) Vitamin B6 and Its Role in Cell Metabolism and Physiology. Cells, 7, 84. https://doi.org/10.3390/cells7070084
[20]
Shin, S.S. and Seung, K.J. (2013) 39. Tuberculosis. In: Magill, A.J., Hill, D.R., Solomon, T. and Ryan, E.T., Eds., Hunter’s Tropical Medicine and Emerging Infectious Disease, 9th Edition, W.B. Saunders, London, 416-432. https://doi.org/10.1016/B978-1-4160-4390-4.00039-4
Lynch, J.B. (2013) Multidrug-Resistant Tuberculosis. Medical Clinics of North America, 97, 553-579. https://doi.org/10.1016/j.mcna.2013.03.012
[23]
Abosamak, N. and Gupta, V. (2021) Vitamin B6 (Pyridoxine). StatPearls Publishing, Treasure Island. https://www.ncbi.nlm.nih.gov/books/NBK557436/
[24]
Vrolijk, M.F., Opperhuizen, A., Jansen, E., Hageman, G.J., Bast, A. and Haenen, G. (2017) The Vitamin B6 Paradox: Supplementation with High Concentrations of Pyridoxine Leads to Decreased Vitamin B6 Function. Toxicology in Vitro, 44, 206-212. https://doi.org/10.1016/j.tiv.2017.07.009
[25]
Sharma, J.B., et al. (2017) Multi Drug Resistant Female Genital Tuberculosis: A Preliminary Report. European Journal of Obstetrics & Gynecology and Reproductive Biology, 210, 108-115. https://doi.org/10.1016/j.ejogrb.2016.12.009
[26]
Manjeet, S.J. and Manik, C. (2018) Cycloserine Induced Suicidal Tendencies and Kanamycin Induced Ototoxicity in Indian MDR-TB Patient: A Case Report. Current Drug Safety, 13, 211-213. https://doi.org/10.2174/1574886313666180605095842
[27]
Cohen, A.C. (1969) Pyridoxine in the Prevention and Treatment of Convulsions and Neurotoxicity Due to Cycloserine. Annals of the New York Academy of Sciences, 166, 346-349. https://doi.org/10.1111/j.1749-6632.1969.tb54286.x
[28]
Girgis, A.S. and Lattimer, J.K. (1962) The Chemotherapy of Genitourinary Tuberculosis with Regimens Using Cycloserine. The Journal of Urology, 87, 9-12. https://doi.org/10.1016/S0022-5347(17)64897-3
[29]
Kwon, H.M., Kim, H.K., Cho, J., Hong, Y.H. and Nam, H. (2008) Cycloserine-Induced Encephalopathy: Evidence on Brain MRI. European Journal of Neurology, 15, e60-e61. https://doi.org/10.1111/j.1468-1331.2008.02171.x
[30]
Liu, Y., et al. (2015) Clinical Outcomes of Linezolid Treatment for Extensively Drug-Resistant Tuberculosis in Beijing, China: A Hospital-Based Retrospective Study. Japanese Journal of Infectious Diseases, 68, 244-247. https://doi.org/10.7883/yoken.JJID.2014.222
[31]
Dauby, N., Muylle, I., Mouchet, F., Sergysels, R. and Payen, M.C. (2011) Meropenem/Clavulanate and Linezolid Treatment for Extensively Drug-Resistant Tuberculosis. The Pediatric Infectious Disease Journal, 30, 812-813. https://doi.org/10.1097/INF.0b013e3182154b05
[32]
Ramírez-Lapausa, M., Pascual Pareja, J.F., Carrillo Gómez, R., Martínez-Prieto, M., González-Ruano Pérez, P. and Noguerado Asensio, A. (2016) Retrospective Study of Tolerability and Efficacy of Linezolid in Patients with Multidrug-Resistant Tuberculosis (1998-2014). Enfermedades Infecciosas y Microbiología Clínica, 34, 85-90. https://doi.org/10.1016/j.eimc.2015.04.003
[33]
Schecter, G.F., Scott, C., True, L., Raftery, A., Flood, J. and Mase, S. (2010) Linezolid in the Treatment of Multidrug-Resistant Tuberculosis. Clinical Infectious Diseases, 50, 49-55. https://doi.org/10.1086/648675
[34]
Swaminathan, A., du Cros, P., Seddon, J.A., Mirgayosieva, S., Asladdin, R. and Dusmatova, Z. (2017) Peripheral Neuropathy in a Diabetic Child Treated with Linezolid for Multidrug-Resistant Tuberculosis: A Case Report and Review of the Literature. BMC Infectious Diseases, 17, 417. https://doi.org/10.1186/s12879-017-2499-1
[35]
Anger, H.A., Dworkin, F., Sharma, S., Munsiff, S.S., Nilsen, D.M. and Ahuja, S.D. (2010) Linezolid Use for Treatment of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis, New York City, 2000-06. Journal of Antimicrobial Chemotherapy, 65, 775-783. https://doi.org/10.1093/jac/dkq017
[36]
Garcia-Prats, A.J., et al. (2019) Pharmacokinetics, Optimal Dosing, and Safety of Linezolid in Children with Multidrug-Resistant Tuberculosis: Combined Data from Two Prospective Observational Studies. PLOS Medicine, 16, e1002789. https://doi.org/10.1371/journal.pmed.1002789
[37]
Youssef, S., et al. (2008) The Role of Vitamin B6 in the Prevention of Haematological Toxic Effects of Linezolid in Patients with Cancer. Journal of Antimicrobial Chemotherapy, 61, 421-424. https://doi.org/10.1093/jac/dkm506
[38]
Spellberg, B., Yoo, T. and Bayer, A.S. (2004) Reversal of Linezolid-Associated Cytopenias, but Not Peripheral Neuropathy, by Administration of Vitamin B6. Journal of Antimicrobial Chemotherapy, 54, 832-835. https://doi.org/10.1093/jac/dkh405
Tugwell, P. and James, S.L. (1972) Peripheral Neuropathy with Ethambutol. Postgraduate Medical Journal, 48, 667-670. https://doi.org/10.1136/pgmj.48.565.667
[41]
Long, K.S. and Vester, B. (2012) Resistance to Linezolid Caused by Modifications at Its Binding Site on the Ribosome. Antimicrobial Agents and Chemotherapy, 56, 603-612. https://doi.org/10.1128/AAC.05702-11
[42]
Rucker, J.C., Hamilton, S.R., Bardenstein, D., Isada, C.M. and Lee, M.S. (2006) Linezolid-Associated Toxic Optic Neuropathy. Neurology, 66, 595-598. https://doi.org/10.1212/01.wnl.0000201313.24970.b8
[43]
Song, T., et al. (2015) Linezolid Trough Concentrations Correlate with Mitochondrial Toxicity-Related Adverse Events in the Treatment of Chronic Extensively Drug-Resistant Tuberculosis. EBioMedicine, 2, 1627-1633. https://doi.org/10.1016/j.ebiom.2015.09.051
[44]
Ramanathan, M.R. and Sanders, J.M. (2017) Chapter 26. Drugs Used in TB and Leprosy. In: Ray, S.D., Ed., Side Effects of Drugs Annual, Vol. 39, Elsevier, Amsterdam, 283-293. https://doi.org/10.1016/bs.seda.2017.06.025
[45]
Hamada, H., Saito, T. and Torii, J. (1979) A Case of Optico-Neuropathy Due to the Treatment with Monoamine Oxidase Inhibitor (Safrazine) (Author’s Transl). Rinsho Shinkeigaku, 19, 379-387. (In JPN)
[46]
Sutton, J., Stroup, J. and Som, M. (2016) Linezolid-Induced Serotonin Toxicity in a Patient Not Taking Monoamine Oxidase Inhibitors or Serotonin Receptor Antagonists. Proceedings (Baylor University. Medical Center), 29, 214-215. https://doi.org/10.1080/08998280.2016.11929423
[47]
Swash, M., Roberts, A.H. and Murnaghan, D.J. (1972) Reversible Pellagra-Like Encephalopathy with Ethionamide and Cycloserine. Tubercle, 53, 132-136. https://doi.org/10.1016/0041-3879(72)90030-X
[48]
Saperstein, D.S. and Barohn, R.J. (2005) Chapter 89. Polyneuropathy Caused by Nutritional and Vitamin Deficiency. In: Dyck, P.J. and Thomas, P.K., Eds., Peripheral Neuropathy, 4th Edition, W.B. Saunders, Philadelphia, 2051-2062. https://doi.org/10.1016/B978-0-7216-9491-7.50092-2
[49]
Gupta, N., Arora, M., Sharma, R. and Arora, K.S. (2016) Peripheral and Central Nervous System Involvement in Recently Diagnosed Cases of Hypothyroidism: An Electrophysiological Study. Annals of Medical and Health Sciences Research, 6, 261-266. https://doi.org/10.4103/amhsr.amhsr_39_16
[50]
Rasool, M., et al. (2015) Determination of Potential Role of Antioxidative Status and Circulating Biochemical Markers in the Pathogenesis of Ethambutol Induced Toxic Optic Neuropathy among Diabetic and Non-Diabetic Patients. Saudi Journal of Biological Sciences, 22, 739-743. https://doi.org/10.1016/j.sjbs.2014.09.019
[51]
Cole, A., May, P.M. and Williams, D.R. (1981) Metal Binding by Pharmaceuticals. Part 1. Copper(II) and Zinc(II) Interactions Following Ethambutol Administration. Agents Actions, 11, 296-305. https://doi.org/10.1007/BF01967631
[52]
Lessell, S. (1976) Histopathology of Experimental Ethambutol Intoxication. Investigative Ophthalmology & Visual Science, 15, 765-769.
[53]
Heng, J.E., Vorwerk, C.K., Lessell, E., Zurakowski, D., Levin, L.A. and Dreyer, E.B. (1999) Ethambutol Is Toxic to Retinal Ganglion Cells via an Excitotoxic Pathway. Investigative Ophthalmology & Visual Science, 40, 190-196.
[54]
Akahane, K., Sekiguchi, M., Une, T. and Osada, Y. (1989) Structure-Epileptogenicity Relationship of Quinolones with Special Reference to Their Interaction with Gamma-Aminobutyric Acid Receptor Sites. Antimicrobial Agents and Chemotherapy, 33, 1704-1708. https://doi.org/10.1128/AAC.33.10.1704
[55]
Tsuji, A., et al. (1988) Inhibitory Effects of Quinolone Antibacterial Agents on Gamma-Aminobutyric Acid Binding to Receptor Sites in Rat Brain Membranes. Antimicrobial Agents and Chemotherapy, 32, 190-194. https://doi.org/10.1128/AAC.32.2.190
[56]
Williams, P.D. and Helton, D.R. (1991) The Proconvulsive Activity of Quinolone Antibiotics in an Animal Model. Toxicology Letters, 58, 23-28. https://doi.org/10.1016/0378-4274(91)90186-A
[57]
Smolders, I., Gousseau, C., Marchand, S., Couet, W., Ebinger, G. and Michotte, Y. (2002) Convulsant and Subconvulsant Doses of Norfloxacin in the Presence and Absence of Biphenylacetic Acid Alter Extracellular Hippocampal Glutamate but Not Gamma-Aminobutyric Acid Levels in Conscious Rats. Antimicrobial Agents and Chemotherapy, 46, 471-477. https://doi.org/10.1128/AAC.46.2.471-477.2002
[58]
Chenel, M., Limosin, A., Marchand, S., Paquereau, J., Mimoz, O. and Couet, W. (2003) Norfloxacin-Induced Electroencephalogram Alteration and Seizures in Rats Are Not Triggered by Enhanced Levels of Intracerebral Glutamate. Antimicrobial Agents and Chemotherapy, 47, 3660-3662. https://doi.org/10.1128/AAC.47.11.3660-3662.2003
[59]
van der Laan, L.E., et al. (2016) Probable Levofloxacin-Associated Secondary Intracranial Hypertension in a Child with Multidrug-Resistant Tuberculosis. The Pediatric Infectious Disease Journal, 35, 706-708. https://doi.org/10.1097/INF.0000000000001137
[60]
Thomas, R.J. and Reagan, D.R. (1996) Association of a Tourette-Like Syndrome with Ofloxacin. Annals of Pharmacotherapy, 30, 138-141. https://doi.org/10.1177/106002809603000205
[61]
O’Brien, J.S. and Sampson, E.L. (1965) Lipid Composition of the Normal Human Brain: Gray Matter, White Matter, and Myelin. Journal of Lipid Research, 6, 537-544. https://doi.org/10.1016/S0022-2275(20)39619-X
[62]
Hanada, K. (2003) Serine Palmitoyltransferase, a Key Enzyme of Sphingolipid Metabolism. Biochimica et Biophysica Acta, 1632, 16-30. https://doi.org/10.1016/S1388-1981(03)00059-3
[63]
Donald, P.R. and McIlleron, H. (2009) Chapter 59. Antituberculosis Drugs. In: Schaaf, H.S., et al., Eds., Tuberculosis, W.B. Saunders, Edinburgh, 608-617. https://doi.org/10.1016/B978-1-4160-3988-4.00059-7
[64]
Chung, S.H., Johnson, M.S. and Gronenborn, A.M. (1984) L-cycloserine: A Potent Anticonvulsant. Epilepsia, 25, 353-362. https://doi.org/10.1111/j.1528-1157.1984.tb04200.x
[65]
Sundaram, K.S. and Lev, M. (1984) Inhibition of Sphingolipid Synthesis by Cycloserine in Vitro and in Vivo. Journal of Neurochemistry, 42, 577-581. https://doi.org/10.1111/j.1471-4159.1984.tb02716.x
[66]
Lowther, J., et al. (2010) Inhibition of the PLP-Dependent Enzyme Serine Palmitoyltransferase by Cycloserine: Evidence for a Novel Decarboxylative Mechanism of Inactivation. Molecular BioSystems, 6, 1682-1693. https://doi.org/10.1039/c003743e
[67]
Laine-Cessac, P., Cailleux, A. and Allain, P. (1997) Mechanisms of the Inhibition of Human Erythrocyte Pyridoxal Kinase by Drugs. Biochemical Pharmacology, 54, 863-870. https://doi.org/10.1016/S0006-2952(97)00252-9
[68]
Imam, F., et al. (2020) Adverse Drug Reaction Prevalence and Mechanisms of Action of First-Line Anti-Tubercular Drugs. Saudi Pharmaceutical Journal, 28, 316-324. https://doi.org/10.1016/j.jsps.2020.01.011
[69]
Nair, S., Maguire, W., Baron, H. and Imbruce, R. (1976) The Effect of Cycloserine on Pyridoxine-Dependent Metabolism in Tuberculosis. The Journal of Clinical Pharmacology, 16, 439-443. https://doi.org/10.1002/j.1552-4604.1976.tb02419.x
[70]
Tang, S., Yao, L., Hao, X., Liu, Y., Sun, H. and Gu, J. (2013) Linezolid for the Treatment of Extensively Drug Resistant Tuberculosis: Multicenter, Randomized Controlled Study. Respirology (Carlton, Vic.), 18, 4.
[71]
Nam, H.S., Koh, W.J., Kwon, O.J., Cho, S.N. and Shim, T.S. (2009) Daily Half-Dose Linezolid for the Treatment of Intractable Multidrug-Resistant Tuberculosis. The International Journal of Antimicrobial Agents, 33, 92-93. https://doi.org/10.1016/j.ijantimicag.2008.06.014
[72]
Park, I.N., et al. (2006) Efficacy and Tolerability of Daily-Half Dose Linezolid in Patients with Intractable Multidrug-Resistant Tuberculosis. Journal of Antimicrobial Chemotherapy, 58, 701-704. https://doi.org/10.1093/jac/dkl298
[73]
Agyeman, A.A. and Ofori-Asenso, R. (2016) Efficacy and Safety Profile of Linezolid in the Treatment of Multidrug-Resistant (MDR) and Extensively Drug-Resistant (XDR) Tuberculosis: A Systematic Review and Meta-Analysis. Annals of Clinical Microbiology and Antimicrobials, 15, 41. https://doi.org/10.1186/s12941-016-0156-y
[74]
von der Lippe, B., Sandven, P. and Brubakk, O. (2006) Efficacy and Safety of Linezolid in Multidrug Resistant Tuberculosis (MDR-TB)—A Report of Ten Cases. Journal of Infection, 52, 92-96. https://doi.org/10.1016/j.jinf.2005.04.007
[75]
Condos, R., Hadgiangelis, N., Leibert, E., Jacquette, G., Harkin, T. and Rom, W.N. (2008) Case Series Report of a Linezolid-Containing Regimen for Extensively Drug-Resistant Tuberculosis. Chest, 134, 187-192. https://doi.org/10.1378/chest.07-1988
[76]
Zhang, P., Li, W., Liu, M., Zhan, S., Zhang, H., Deng, G. and Chen, X. (2022) Linezolid-Associated Neuropathy in Patients with MDR/XDR Tuberculosis in Shenzhen, China. Infection and Drug Resistance, 15, 2617-2624. https://doi.org/10.2147/IDR.S365371
[77]
Singhal, P., Lunia, P., Salgia, K. and Syed, I. (2020) Incidence of Cycloserine Induced Neurotoxicity in Drug Resistant TB Patients Attending a Tertiary Care Hospital. European Respiratory Journal, 56, 1593. https://doi.org/10.1183/13993003.congress-2020.1593
[78]
Ormerod, L.P. and Horsfield, N. (1996) Frequency and Type of Reactions to Antituberculosis Drugs: Observations in Routine Treatment. Tubercle and Lung Disease, 77, 37-42. https://doi.org/10.1016/S0962-8479(96)90073-8
[79]
Thee, S., Garcia-Prats, A.J., Donald, P.R., Hesseling, A.C. and Schaaf, H.S. (2016) A Review of the Use of Ethionamide and Prothionamide in Childhood Tuberculosis. Tuberculosis, 97, 126-136. https://doi.org/10.1016/j.tube.2015.09.007
Fortún, J., et al. (2005) Linezolid for the Treatment of Multidrug-Resistant Tuberculosis. Journal of Antimicrobial Chemotherapy, 56, 180-185. https://doi.org/10.1093/jac/dki148
