Introduction
At Pro-Gene Diagnostics and Research Laboratory and Mardan Medical Complex, we are committed to advancing the understanding of treatment-related challenges in multidrug-resistant tuberculosis (MDR-TB). While the BPaLM regimen a combination of bedaquiline, pretomanid, linezolid, and moxifloxacin has improved treatment outcomes, its side effects remain a concern. Our recent study focuses on two key toxicities: arthralgia (joint pain) and peripheral neuropathy (nerve damage), both of which can significantly impact patient quality of life and treatment adherence.
Key Toxicities: Arthralgia and Peripheral Neuropathy
- Arthralgia (Joint Pain):
Joint pain emerged as one of the most common musculoskeletal issues in MDR-TB patients on BPaLM. Knees were most frequently affected, often appearing within three months of treatment initiation. - Peripheral Neuropathy (Nerve Damage):
Numbness, tingling, and weakness, particularly in the lower limbs, were frequent neurological complications. Neuropathy symptoms generally developed after 100 days of therapy and varied in severity.
Together, these toxicities highlight the need for regular monitoring and personalized interventions to ensure patients can continue treatment successfully.
Study Findings and Clinical Implications
High Prevalence of Side Effects
- 79.5% of patients experienced mild to moderate arthralgia.
- 59% developed peripheral neuropathy, with the lower limbs being most affected.
Risk Factors Identified
- Older age and higher BMI were linked to more severe arthralgia.
- Diabetes and sedentary lifestyles increased the likelihood of neuropathy.
Treatment and Supportive Care
- Analgesics provided complete pain relief for 75% of patients.
- Physical therapy was effective in improving mobility and reducing discomfort in selected cases.
Survival Impact
Kaplan-Meier survival analysis revealed that severe joint pain and neuropathy correlated with reduced treatment survival times, emphasizing the importance of early detection and proactive management.
Advancing MDR-TB Treatment Strategies
Our findings underscore the importance of integrating patient-centered care into MDR-TB treatment:
- Routine Monitoring: Regular assessment for musculoskeletal and neurological toxicities.
- Targeted Interventions: Early use of analgesics, neuropathic pain management, and physical therapy.
- Lifestyle Focus: Encouraging physical activity to reduce severity of side effects.
- Risk-Based Care: Extra vigilance for patients with comorbidities such as diabetes.
Conclusion
This study highlights the significant role of arthralgia and peripheral neuropathy in shaping treatment experiences for MDR-TB patients on the BPaLM regimen. By recognizing risk factors early and applying supportive management strategies, clinicians can help improve both treatment adherence and quality of life.
At Mardan Medical Complex, we remain committed to research that strengthens patient-centered TB care, ensuring effective therapies are balanced with strategies that minimize toxicity.
Full article available at https://pubmed.ncbi.nlm.nih.gov/40548154/.