Impact of Yuehua Decoction on quality of life and safety in multidrug-resistant tuberculosis: a prospective cohort study using multivariable regression analysis

Background Multidrug-resistant tuberculosis (MDR-TB) remains a major global health challenge, and prolonged chemotherapy often leads to substantial symptom burden and impaired health-related quality of life (HRQoL). Host-directed adjunctive therapies, including Traditional Chinese Medicine, have received growing interest; however, prospective clinical evidence on Yuehua Decoction remains limited. This study evaluated whether adjunctive Yuehua Decoction improves HRQoL and safety among patients receiving standardized MDR-TB treatment. Methods We conducted a prospective, non-randomized cohort study enrolling adults with microbiologically confirmed MDR-TB. Patients received either standard MDR-TB chemotherapy alone (control group) or in combination with Yuehua Decoction (Yuehua group) based on treatment preference. The primary outcome was HRQoL at 6 months, assessed using the St. George's Respiratory Questionnaire (SGRQ). Between-group differences were analyzed using multivariable linear regression adjusting for baseline SGRQ and other clinically relevant covariates. Secondary outcomes included sputum culture conversion and treatment-related adverse events. Results Seventy-one patients were included (Yuehua group, n = 32; control group, n = 39). Although demographic characteristics were similar, baseline SGRQ scores were significantly higher in the Yuehua group ( P = 0.007). After adjustment for this imbalance, adjunctive Yuehua Decoction was associated with greater improvement in SGRQ total score at 6 months (adjusted β = -3.00; 95% CI: -3.87 to -2.12; P P = 0.038), with no increase in serious adverse events. Conclusion In this preliminary prospective cohort, adjunctive Yuehua Decoction was associated with improved HRQoL without increasing treatment-related toxicity among patients undergoing MDR-TB chemotherapy. These findings support Yuehua Decoction as a potential host-directed adjunct, but confirmation in larger randomized controlled trials is needed.