Effect of Diabetes on Rifampicin Levels in Patients with Tuberculosis

 

Diabetes

According to the findings of a recent systematic review and meta-analysis published in the journal Therapies, patients with diabetes mellitus (DM) and tuberculosis (TB) had a significantly higher incidence of low rifampicin plasma levels two hours after the anti-tubercular drug was administered than patients with TB who did not have DM.

The ability of rifampicin to kill bacteria and sterilize them makes it an essential component of TB therapy regimens, thus the researchers wanted to assess how DM affected the drug's plasma concentrations and bioavailability. They stated that rifampicin dosage modification has the potential to result in better patient outcomes and may shorten the course of treatment.

Diabetes & Tuberculosis Infection

Generally, there is a complex passive interaction between TB and DM. Some people may acquire DM as a result of the stress hyperglycemia that is linked to TB. Additionally, DM patients have a 3-fold higher chance of developing TB. An altered immunologic response is one of the numerous mechanisms by which DM affects the effectiveness of TB treatment.

Based on its impact on the incidence of low rifampicin plasma concentrations 2 hours after injection, the studies selected for analysis computed a risk portion for DM. The meta-analysis comprised 17 trials in all, involving 3478 TB patients.

The review's findings revealed that low rifampicin plasma levels occurred more frequently in individuals with DM and TB (risk ratio: 1.59; 95 percent confidence interval: 1.16-2.19; P =.004).

TB & Diabetes Comorbidity

Additionally, there was no hint of publication bias when comparing patients with TB and DM to those with TB alone in terms of the overall rifampicin plasma concentration at 2 hours (mean difference, -1.4; 95 percent CI, -2.65 to -0.15; P =.03).

The occurrence of low rifampicin plasma concentrations 2 hours after drug administration had a 37% associated risk percentage of DM. There were no discernible differences in rifampicin maximum plasma concentration, an event of low maximum plasma concentration, bioavailability, or half-life between the DM-plus-TB group and the TB-only group.

Researchers claim that while treating TB in the intensive phase, "DM does not modify the pharmacokinetics of anti-tubercular medicines," but that "it likely reduces rifampin exposure during the continuation phase." Additionally, it was proposed by the investigators that variations in rifampicin induction might account for "variance in the influence of DM on the pharmacokinetics of anti-tubercular medicines during the TB phases of treatment."

Comorbidity

Due to the few studies that were included in the meta-analysis, the researchers advised that the results should be read with care. The covariates of glycated hemoglobin, fasting plasma glucose, BMI, and family income, all of which are judged necessary for subsequent subgroup analysis, were not reported in the majority of the studies.

The researchers also concluded that the treatment of DM, the patient's income, the type of TB involved, and any recurrence of TB all had an impact on the passive effect of DM on rifampicin plasma concentrations 2 hours after administration.

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