Multidrug-resistant TB (MDR-TB) is a type of tuberculosis that does not respond to at least isoniazid and rifampicin. The two routinely used anti-TB drugs. Combination therapy with multiple second-line drugs can be used, but it is associated with adverse events leading to severe morbidity. This study aims to estimate the absolute and relative frequency of adverse events associated with using second-line treatment drugs for MDR-TB.

This individual-level patient data meta-analysis included 35 studies that reported adverse events resulting in permanent discontinuation of anti-tuberculosis medications. Studies contributing to patient-level data in response to WHO-made public calls were also considered. The primary outcome of the study was to recognize the incidence of adverse events for each TB drug.

Thirty-five studies were included in the analysis that comprised data of 9,178 patients. A meta-analysis of proportions suggested the following drugs with low risk of adverse event occurrence: levofloxacin (1.3%), moxifloxacin (2.9%), bedaquiline (1.7%), and clofazimine (1.6%). Contrarily, drugs with a relatively high incidence of adverse events were amikacin (10.2%), kanamycin (7.5%), capreomycin (8.2%), aminosalicylic acid (11.6%), and linezolid (14.1%).

The research concluded that among second-line drugs used to treat MDR-TB, fluoroquinolones, bedaquiline, and clofazimine had the lowest incidence of adverse events, and aminosalicylic acid, linezolid, and injectable drugs had a higher incidence of adverse events.