PP3 PREVALENCE OF CUTANEOUS ADVERSE DRUG REACTION (CADR) TO THE FIRST-LINE ANTI-TUBERCULOSIS DRUGS IN HOSPITAL PULAU PINANG, MALAYSIA

Man Ee Chiew1, Shankari Venugopal1, Jaya Muneswarao2, Jasdyl Singh Shadan1, Subashree Kumaresan1, Lalitha Pereirasamy 1
1Department of Respiratory Medicine, Hospital Pulau Pinang, Georgetown, Malaysia
2Department of Pharmacy, Hospital Pulau Pinang, Georgetown, Malaysia

Introduction:

Anti-tuberculosis (Anti-TB) drugs can lead to cutaneous adverse drug reactions (CADR). The data related to CADR in Malaysia is limited.

Objectives:

This study aimed to assess the prevalence and types of CADR to first-line anti-TB in Hospital Pulau Pinang.

Methodology:

This retrospective study reviewed outpatient medical records from June 2022 to June 2023. The diagnosis and severity of CADR were determined by the patient case documentation and expert evaluation by pulmonologists, dermatologists and pharmacists.

Results:

Fifty patients developed CADR out of 549 TB patients, documenting a prevalence of 9.1%. Both genders are equally affected by CADR. High-risk groups include patients between 41 and 60 years old (36%), tertiary sector workers (46%), non-smokers (66%) and patients with pre-existing comorbidities (68%). The three most common CADRs were maculopapular rash (46%), erythema (42%), and urticaria (10%). Ninety-two percent of CADRs occurred during the intensive phase of treatment. The fixed-dose combination (FDC) was responsible for 90% of CADRs, meanwhile pyrazinamide was the commonest individual offending drug. Forty percent of patients who experienced CADRs improved with symptomatic treatment without any change in the regime, while 28% of patients who developed reactions to the FDC were successfully re-challenged with all individual drugs, indicating the additives in the FDC may be the culprit.

Conclusion:

The commonest type of CADR in this study was maculopapular rash, and typically the individual offending drug was pyrazinamide. Ninety per cent of the patients developed CADR to FDC, however, nearly half of them managed to tolerate it with symptomatic treatment.