Table 2. Effect of anti-tuberculous therapy on serum uric acid from this study and that previously reported Authors,
year
Country Type of study
N Regimen Definition of hyperuricemia
(mg/dL)
SUA levels prior to initiation
of anti- TBD (mg/dL)
SUA levels after anti-
TBD (mg/dL)
Hyperuricemia after anti-TBD
Comments Joint
symptoms
ZE containing regimen Present
study, 2015
Thailand Pros. 16 2IRZE
+4IR9 (study duration 4 Mo)
> 6.8 4.44 9.78 at Wk2,
9.42 at Mo2
81.25% Significant increase in SUA at Wk2, and Mo2 (p <
0.001)
Arthralgia in 1 case (6.25%), and tuberculous arthritis in 1 (6.25%) Nahar BL, et
al., 200617
Bangladesh Pros. 34 IRZE (n = 14)
ND 4.86 6.22 at Wk4,
6.34 at Wk8
No significant changes in SUA in either group during treatment.
SUA increased in 55.88% of cases
35.71%
IRZESp (n = 20)
4.48 5.57 at Wk4, 5.74 at Wk8
Gulbay BE, et al., 200616
Turkey Retro. 1149 2IRZE(S) + 7IR
> 8.0 NA NA 2.7% Median time of
17.6 days to hyperuricemia (range 5-30 days). 0.6% of
0.3%. No response to NSAIDs
cases required discontinuation of Z
Koju D, et al., 200515
Nepal Pros. 70 IRZES ND 4.47 4.63 at Mo1 No significant
changes in SUA during treatment
41.43%.
Related to Z
Solangi GA, et al., 200414
Pakistan Pros. 216 2IRZE + IRE (study duration 12 Wk)
ND 5.07 9.68 at Wk2,
9.64 at Wk8, and 5.08 at Wk12
6.38% Significant
increase in SUA at Wk2 (p < 0.001)
Arthritis symptom in 4.3%.
Adebisi SA, et al., 200213
Nigeria Pros. 31 2IRZE + 4IR
> 7.17 (mean + 2SD of
controls)
5.22 7.63 at Mo1, 8.57 at Mo2, and 5.64 at Mo4
6.5% at
baseline, 51.6%
at Mo1, 48.4%
at Mo2, and 16.5% at Mo4
Significant increase in SUA at Mo1 (p = 0.001) and Mo2 (p = 0.002) Significant decrease in 24-hr UUA excretion from 812 mg to 568 mg, p < 0.05) at Mo1
NM
Khanna BK, et al., 199112
India Retro. 75 IZE,
IRZE, or IRZES (n =23)
ND 4.55 (n =
21)
7.51 at Wk4, 8.81 at Wk8 (n
= 21)
17.39% at wk1, 86.95% at Wk2, 91.34% at Wk4 (n = 23)
17.40%
Z containing regimen Balouch GH,
et al., 201118
Pakistan Retro. 119 IRZ > 7.1 NA NA 13.4% at >
Mo2
No SUA levels provided.
Higher prevalence of hyperuricemia in males
NM
Khanna BK, et al., 199112
India Retro. 74 IRZ or
IZS (n = 19)
ND 4.39 (n =
14)
7.93 at Wk4, 8.62 at Wk8 (n
= 14)
26.31% at Wk1, 68.42% at Wk2, and 73.68% at Wk4 (n = 19)
15.80%
Sarma GR, et al., 198310
India Pros. 45 IRZS
( n =21)
ND 3.36 8.57 at D1,
8.41 at Wk1, and 8.91 at Wk 2
Significant increase in SUA at D1 in both groups (p < 0.001) Significant decrease in uric acid clearance (from 13.7
NM
IZS (n =24)
3.36 8.91 at D1, 8.91 at Wk1, 9.58 at Wk2
ml/min to 2.5 ml/min, p <
0.001) at D15, and 24-hr UUA excretion (from 513 to 242 mg, p <
0.001) at D15 Jenner PJ, et
al., 19818
Hong Kong
Pros. 184 2-3 IRZS (n = 26*)
ND 5.21 11.94 at Mo1,
11.94 at Mo2, and 11.77 at Mo3
Significant increase in SUA at Mo1, Mo2 and Mo3 (p < 0.001)
NM
3IPS + 9I2S2
(n = 13*)
5.21 4.54 at Mo1, 5.04 at Mo2, and 4.70 at Mo3 Singapore Pros. 136 2IRSZ +
2-4IR(Z) (n = 18*)
ND 4.37 11.94 at Mo1,
13.79 at Mo2
Significant increase in SUA at Mo1 and Mo2 (p <
0.001) in both groups
4.41%
2IRSZ + 2-4IR(Z) (n = 6**)
4.53 12.95 at Mo1, 11.10 at Mo2
Hong Kong Tuberculosis Treatment
Hong Kong
Pros. 899 IZS (n = 20*)
ND 4.2 12.6 at Mo2,
14.5 at Mo5
Significantly higher SUA in IZS than in
Arthralgia was more common in patients
I3Z3S3 4.4 7.4 at Mo2, 9.4
Service, 19767
(n =20*) at Mo 5 I3Z3S3 and
I2Z2S2 at Mo2 and Mo5. SUA of I3Z3S3 was higher than that of I2Z2S2
at Mo5
receiving daily I2Z2S2 Z
(n=20*)
5.2 7.7 at Mo2, 7.2 at Mo 5
Shapiro, M, et al., 19576
USA Pros. 34 IPSZ ND < 5.4 (n =
24)
> 5.4 in all (range 5.9- 11.6)
91.66% had SUA > 6.8
SUA increased as early as 24 hours after starting Z
0%
E containing regimen Khanna BK,
et al., 199112
India Retro. 73 IRE or
IRS (n =31)
> 6.5 4.25 (n = 16)
6.57 at Wk4, 7.27 at Wk8 (n
= 16)
0% at wk1, 19.95% at Wk2, and 51.61% at Wk3 (n = 31)
No statistical calculation was performed
3.20%
Khanna BK, et al., 198411
India Pros. 147 ISE
(n = 79, complete
= 71)
> 6.55 (normal range)
4.38 6.99 at D45, 7.58 at D90
66% Significant
increase in SUA in the E group after D15 (p < 0.001)
Gout developed in 2 cases at D37, and D50, respectively.
No
arthrocentesis was performed IST
(n = 68, complete
4.62 4.57 at D45, 4.60 at D90
0%
= 60) Narang RK,
et al., 19839
India Pros. 70 IE + ISE
(n = 52)
ND 4.37 5.21 at Wk1,
5.71 at Wk2, 6.89 at Wk3, and 6.56 at Wk4
SUA increased in 57.69% of cases
Significant increase in SUA occurred in the E group at Wk2, Wk3 and Wk4 (p <
0.05)
3.85%
IS (n= 18)
4.54 4.45 at Wk1, 2, 3 and 4
Postelthwaite AE, et al., 19723
USA Retro. 24 IE(±S)
(n = 15)
ND 2.4 (n =
8/15)
5.6 at Mo1 (n
= 8/15)
47% of cases had increased SUA
SUA increased as early as 24 hour after starting E, or as late as D90
NM
Pros. IE
(n =9)
NA (n = 8/9)
Increase SUA from baseline of more than 2.4 mg/dL (n
= 8/9)
89% had increased SUA
SUA = serum uric acid, anti-TBD = anti-tuberculous drugs, I = isoniazid, R = rifampicin, Z = pyrazinamide, E = ethambutol, P = paraaminosalicylic acid, T = thioacetazone, Sp = sparfloxacin, Wk = week, Mo = month, D = day, * = number of patients who had SUA tested, ** = number of patients who had arthralgia and SUA tested, ND = not defined, NA = not available, NM = not mentioned, NSAIDs = non-steroidal anti-inflammatory drugs.
Pros. = prospective study, Retro. = retrospective study.