Assessment of Pyrazinamide-Associated Hyperuricemia Among Multidrug-Resistant Tuberculosis Patients Receiving Pyrazinamide-Containing Regimens: A Retrospective Cross-Sectional Study from Sudan
Mayada E. Abdelrahman
Department of Pharmacy Practice, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan.
Fatima S. Naim
Department of Pharmacy Practice, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan.
Mawahib A. Mustafa
Department of Pharmacy Practice, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan and Department of Pharmacology and Toxicology, School of Pharmacy, Kampala International University, Ishaka, Uganda.
Elkhanssa Abdelhameed Ahmed Elhag
Department of Pharmacy Practice, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan.
Mohammed H. Alnazeer
Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan.
Kannan O. Ahmed
Department of Pharmacy Practice, College of Pharmacy, National University of Science and Technology, Muscat, Oman and Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Gezira, Wad Medani, Sudan.
Orwa Siddig
Department of Pharmaceutical Chemistry and Analysis, School of Pharmacy, Kampala International University, Ishaka, Uganda.
Bashir A. Yousef
*
Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan and Department of Clinical Pharmacy and Pharmacology, Ibn Sina College for Medical Studies, Jeddah, Saudi Arabia.
*Author to whom correspondence should be addressed.
Abstract
Background: Tuberculosis (TB) is still one of the most important causes of morbidity and mortality worldwide. The problem multiplies whenever there is multidrug-resistant TB (MDR-TB), due to Mycobacterium tuberculosis susceptibility to both Rifampicin and Isoniazid. Pyrazinamide (PZA) is often added to TB regimens if there is susceptibility; however, one adverse reaction to it is that it causes hyperuricemia. This study was conducted to investigate hyperuricemia induced by PZA among MDR-TB patients attending the Abu Ajja Teaching Hospital in the State of Khartoum, Sudan.
Methods: A retrospective cross-sectional study was carried out among 84 MDR-TB patients who received treatment in the hospital’s MDR-TB ward during 2020-2021. Serum uric acid measurements (pre-PZA baseline values and months 1-5 post-PZA treatment initiation) were obtained by spectrophotometry. The data was analyzed with paired t-test to compare each group to the baseline values. A p-value < 0.05 was taken to be statistically significant.
Results: Among the study population, 67.9% were male, and 48.8% were aged between 18 and 30 years. The majority (89.3%) were Sudanese, and 58.3% were classified as underweight. The mean baseline serum uric acid level prior to PZA therapy was 4.47 ± 1.17 mg/dL. Following the initiation of PZA, a progressive and statistically significant increase in serum uric acid was observed across all subsequent months: 8.67 ± 2.39 mg/dL (p < 0.001) in month 1, 8.94 ± 2.07 mg/dL (p < 0.001) in month 2, 9.04 ± 1.89 mg/dL (p < 0.001) in month 3, and 9.56 ± 1.85 mg/dL (p < 0.001) in month 4. By month 5, the mean serum uric acid level further increased to 9.69 ± 1.96 mg/dL (p < 0.001) compared with baseline values.
Conclusion: In this group of patients with MDR-TB undergoing PZA-containing regimens, there was a statistically significant increase in the levels of uric acid in the blood during the initial five months of treatment. These results highlight the need to take uric acid levels into consideration during TB treatment regimens that include PZA, even in resource-limited centers.
Keywords: Pyrazinamide, tuberculosis, multidrug-resistant tuberculosis, hyperuricemia, uric acid monitoring, Sudan