Zhang Peize, Li Wei, Liu Miaona, Zhan Senlin, Zhang Hailin, Deng Guofang, Chen Xiaoyou
Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, People's Republic of China.
Department of Pulmonary Medicine and Tuberculosis, The Third People's Hospital of Shenzhen, Shenzhen, Guangdong, People's Republic of China.
Infect Drug Resist. 2022 May 23;15:2617-2624. doi: 10.2147/IDR.S365371. eCollection 2022.
Linezolid is one of the key drugs for the treatment of multidrug-resistant/extensively drug-resistant tuberculosis (MDR/XDR-TB). We aimed to describe the incorporation of the Michigan Neuropathy Screening Instrument (MNSI) and serum trough concentration as screening tools for neurotoxicity in the management of MDR/XDR-TB patients receiving a linezolid-based treatment regimen in Shenzhen, China.
A total of 73 patients on a linezolid-containing anti-MDR/XDR-TB regimen were prospectively enrolled. The MNSI was used for peripheral neuropathy screening. Optic neuropathy was diagnosed by ophthalmologists. Serum trough concentration was recorded and its relationship with neuropathy analyzed.
Of all patients, neuropathy was observed in 40% (29) during anti-TB treatment. Of these, 20 (69%) had peripheral neuritis, seven (24%) optic neuritis, and two (7%) both. Serum trough concentration >2 mg/L was observed in 17 (59%) patients with neuropathy and 13 (30%) patients without neuropathy. There was a significant statistical difference between the two groups (=0.013). Time to onset of neuropathy from initiation of the linezolid-containing regimen was within 2 months for eight (28%) patients, 2-6 months for 18 (62%) patients, and >6 months for three (10%) patients. Sixteen (55%) patients were adjusted to a lower dose of 300 mg linezolid daily. Four (14%) patients had linezolid permanently removed from their regimen.
Neuropathy is a commonly reported adverse event associated with long-term use of linezolid. MNSI and serum trough-concentration monitoring can be adopted as simple screening tools for early detection of neuropathy to balance linezolid efficacy and tolerability.
利奈唑胺是治疗耐多药/广泛耐药结核病（MDR/XDR-TB）的关键药物之一。我们旨在描述将密歇根神经病变筛查工具（MNSI）和血清谷浓度作为神经毒性筛查工具，用于在中国深圳接受以利奈唑胺为基础治疗方案的MDR/XDR-TB患者管理中的情况。
前瞻性纳入了73例接受含利奈唑胺抗MDR/XDR-TB方案治疗的患者。使用MNSI进行周围神经病变筛查。由眼科医生诊断视神经病变。记录血清谷浓度并分析其与神经病变的关系。
在所有患者中，40%（29例）在抗结核治疗期间出现神经病变。其中，20例（69%）患有周围神经炎，7例（24%）患有视神经炎，2例（7%）两者均有。在17例（59%）出现神经病变的患者和13例（30%）未出现神经病变的患者中观察到血清谷浓度>2mg/L。两组之间存在显著统计学差异（P=0.013）。从开始含利奈唑胺方案到出现神经病变的时间，8例（28%）患者在2个月内，18例（62%）患者在2至6个月内，3例（10%）患者超过6个月。16例（55%）患者调整为每日300mg利奈唑胺的较低剂量。4例（14%）患者的治疗方案中永久停用了利奈唑胺。
神经病变是长期使用利奈唑胺常见的不良事件。MNSI和血清谷浓度监测可作为早期检测神经病变的简单筛查工具，以平衡利奈唑胺的疗效和耐受性。
