Treatment of Multi-Drug-Resistant Tuberculosis with Second-Line All-Oral Drugs in Ghana: Incidence of Adverse Events.
Introduction: The treatment of multidrug-resistant tuberculosis (MDR-TB) remains challenging due to the toxicity of second-line medications and suboptimal treatment outcomes. This study aimed to determine the incidence of adverse events and identify factors associated with these events in patients undergoing treatment for MDR-TB with second-line all-oral drugs in Ghana. Methods: This retrospective cohort study reviewed the medical records of 384 MDR-TB patients treated with second-line all-oral drugs at selected health facilities in Ghana, including the Greater Accra Regional Hospital, Eastern Regional Hospital, and Kumasi South Hospital. Data were extracted using the Kobo Collect tool, capturing patient demographics, baseline clinical and laboratory characteristics, treatment regimens, and adverse events. The study period spanned from 2020 to August 2024. Results: The study included a total of 384 MDR-TB patients, with a mean age of 45 years (SD = 15). The majority of patients were male (65.78%), and most were within the 45-64 years age group (33.85%), followed by those aged 25-44 years (31.25%). Regionally, the highest number of cases were reported from the Greater Accra Region (39.06%), followed by the Eastern Region (31.25%) and Kumasi South Hospital (29.69%). Approximately one in four patients (25%) presented with comorbidities, with HIV being the most common (19.5%). The most frequently reported adverse events were diarrhea (14%), dizziness (13.7%), and vomiting (12.3%). Most of these were mild to moderate in severity and tended to decrease as treatment progressed. Severe adverse events, such as leukopenia and acute kidney injury, were rare, occurring in less than 5% of patients. Over the course of treatment, gastrointestinal adverse events such as vomiting and nausea showed a significant decline, indicating possible patient adaptation or improved clinical management. Results from the multivariate Poisson regression analysis revealed that age and comorbidities were significant predictors of adverse events. Patients aged 65 years and above had a 56% lower risk of developing adverse events compared to younger patients (Adjusted Risk Ratio [aRR] = 0.44, 95% CI: 0.25-0.79, p = 0.005). Conversely, patients with comorbid conditions such as diabetes or hypertension were approximately 2.6 times more likely to experience adverse events compared to those without comorbidities (aRR = 2.65, 95% CI: 1.58-4.43, p < 0.001). The effect of sex was not statistically significant after adjustment (aRR = 1.03, 95% CI: 0.70-1.50, p = 0.86). At the end of the treatment period, 74.9% of patients achieved successful outcomes, including both those who were cured and those who completed treatment without being classified as cured. However, 25.1% had unsuccessful outcomes, which included treatment failure, relapse, or death. Conclusion: In conclusion, adverse events are common in the treatment of MDR-TB with second-line All-Oral drugs, with gastrointestinal adverse events being the most prevalent. These findings highlight the importance of monitoring and managing adverse events to optimize treatment outcomes for MDR-TB patients in Ghana.