Meta-analysis shows linezolid-containing regimens for multidrug/rifampicin-resistant tuberculosis

This meta-analysis synthesized data from 3019 patients to evaluate the impact of linezolid-containing regimens compared to standard of care for multidrug/rifampicin-resistant tuberculosis. The analysis focused on clinical outcomes including unfavorable outcomes, sputum culture conversion, and various adverse events.

Regarding efficacy, the linezolid group demonstrated fewer unfavorable outcomes with a risk difference of RD -0.150 (95% CI -0.211 to -0.089). Additionally, the linezolid group showed higher sputum culture conversion with a risk difference of RD 0.047 (95% CI 0.003 to 0.092).

Safety data indicated that linezolid-containing regimens did not significantly increase the rates of myelosuppression, gastrointestinal, renal, or hepatic disorders. However, peripheral neuropathy was higher in the linezolid group with a risk difference of RD 0.043 (95% CI 0.005 to 0.081).

Evidence regarding tolerability suggests that lower-dose (≤600 mg) or shorter-duration (≤9 months) regimens demonstrated comparable tolerability. Furthermore, lower doses or shorter durations were associated with fewer adverse events and less AE-related treatment discontinuation. Clinical application should consider these dosing and duration factors to manage neurological risks.