P137 Drug-induced liver injury in tuberculosis treatment: a retrospective review from a district general hospital

<h3>Introduction</h3> Treatment of tuberculosis (TB) entails a small but significant risk of drug-induced liver injury (DILI); this can have an adverse effect on treatment adherence, in addition to the impact of the DILI itself. We describe the number and characteristics of patients having DILI during TB treatment, their monitoring and alterations to treatment, and the associated outcomes. <h3>Methods</h3> All cases of TB completing treatment between 2018 and 2023 inclusive were identified, amounting to 179 patients. As TB treatment related DILI is hepatitic, serum alanine transaminase (ALT) was used as a marker of DILI; this was then classified based on BTS guidelines,¹ with mild being a raised ALT below 2× the upper-limit of normal (ULN), moderate as 2×ULN or above, but below 5×ULN, and severe as 5×ULN or more. The notes and clinic letters were then reviewed to determine whether monitoring and treatment modification were in line with the same guidelines. <h3>Results</h3> We identified 50 patients with evidence of abnormal liver enzymes. There was a male predominance. The White and South Asian subgroups had the highest levels of DILI. Treatment was stopped in 10 (20%) patients, although one was because of Ethambutol induced visual disturbance. Of those with treatment interruption, all were successfully re-challenged and completed treatment. None of the patients developed fulminant liver failure. Monitoring and treatment modification was as per guidelines in 32 (64%) of overall patients; non-compliance was around monitoring of patients who had mild or moderate DILI with repeat blood tests. <h3>Conclusion</h3> DILI is a potentially severe side-effect of anti-tuberculous medication. In this study, 50 (28%) of patients had DILI with 6 (12%) having a severe form warranting treatment interruption. Patients with mild and moderate DILI had spontaneous resolution. Further work is needed to risk assess patients for DILI prior to treatment initiation. In addition, review of current guidance on the monitoring of patients who develop mild or moderate DILI is needed, as spontaneous resolution was seen in the majority of patients. <h3>Reference</h3> Joint Tuberculosis Committee of the British Thoracic Society. Chemotherapy and management of tuberculosis in the United Kingdom: Recommendations 1998. <i>Thorax</i>. 1998;<b>53</b>(7):536–548.