Fenofibrate is associated with higher risk of mortality in patients with tuberculosis infection

<b>Objectives:</b> Mycobacterium tuberculosis (Mtb) is an intracellular pathogen that infects and persists in foamy macrophages, which causes tuberculosis (TB). Regulating cholesterol in macrophages may affect the intracellular growth of Mtb. However, the association between lipid-lowering therapy and TB disease remains unclear. The aim of the study is to investigate the use of fenofibrate, a lipid-lowering drug, and its outcome in patients with TB infection. <b>Methods:</b> Nationwide epidemiological data from the National Health Insurance Research Database of Taiwan were used. Patients with new onset of TB and those who had ever been prescribed fenofibrate in 2000 were eligible for inclusion in this study. TB patients without any use of fenofibrate therapy were recruited for the comparator cohort. All patients were followed up until death or December 31, 2010. The outcome was all-cause death during study period. <b>Results:</b> As the study cohort, 605 individuals who had been diagnosed with TB and received fenofibrate in 2000 were identified. Another 2,420 TB subjects without fenofibrate usage were randomly selected as the comparison cohort. During 11 years of follow-up, there were 108 deaths (17.9%) in the study cohort, and 354 (14.6%) in the comparison cohort. However, the risk of death was higher in those TB patients who were treated with fenofibrate (log-rank p values = 0.035). Longer duration of fenofibrate use (&gt; 1 year) may be associated with significantly higher risk of mortality (log-rank p values &lt; 0.001). <b>Conclusions:</b> Longer use of fenofibrate in patients with TB is associated with higher risk of mortality.