Hepatoprotective drugs for prevention of liver injury resulting from anti-tuberculosis treatment: A meta-analysis of cohort studies

The incidence of liver injury caused by anti-tuberculous (TB) drugs is very high. However, owing to a lack of sufficient evidence, preventive use of hepatoprotective drugs is not yet recommended. Therefore, we aimed to assess the protective effect of hepatoprotective drugs for anti-TB drug-induced liver injury.We conducted a literature search in China Biology Medicine disc, China National Knowledge Infrastructure, WanFang, Chinese Scientific and Technological Journal, PubMed, Cochrane Library, Web of Science, and Embase. We performed meta-analysis using R 4.0 and Review Manager 5.3 software.A total of 18 studies involving 3589 patients from 2 groups were included. Use of hepatoprotective drugs contributed to a lower incidence of liver injury as compared with conventional anti-TB treatment alone (relative risk [RR] = 0.39, 95% confidence interval [CI]: 0.28-0.53, p < 0.001). In subgroup analysis, significant protective effects were noted for mild liver injury (RR = 0.30, 95% CI 0.15-0.58), moderate (or severe) liver injury (RR = 0.35, 95% CI 0.19-0.65), and liver injury within 2-4 weeks (RR = 0.37, 95% CI 0.19-0.71). We also found a statistically significant difference in the incidence of drug withdrawal (RR = 0.58, 95% CI 0.34-0.97, p = 0.040).Our results demonstrate that hepatoprotective drugs are effective in preventing liver injury in patients receiving anti-TB treatment, to some extent.