Effectiveness of the hepatoprotective activity of reamberine, remaxol, and ademethionine and risk assessment in their use in patients with respiratory tuberculosis and drug-induced liver injury

Aim. To comparatively evaluate the hepatoprotective activity of reamberine, remaxol, and exogenous ademethionine and a risk for unfavorable/favorable outcomes of their use in patients with liver injury during antituberculosis chemotherapy. Subjects and methods. One hundred and eighty patients with new-onset respiratory tuberculosis were examined and divided into 4 groups (45 patients in each group): Study Group 1 (SG1): patients who took reamberine; Study Group 2 (SG2): those who received remaxol; Study Group 3 (SG3): those who had ademethionine; and a Comparative Group (CG): those who received 5% glucose solution. The test drugs were intravenously administered in a dropwise manner once daily for 10 days. The laboratory hepatic injury severity index (LHISI) was estimated according to the method described by T.N. Kalachnyuk and the risk for a favorable/unfavorable outcome was assessed, by calculating the average cost of the used hepatotropic agents. Results. LHISI increased statistically significantly with the development of liver injury induced by antituberculosis agents. There was a statistically significant reduction in LHISI during therapy with the test hepatotropic agents versus glucose solution, the most pronounced activity being shown by remaxol. Relative risk (RR) and odds ratio (OR) assessments revealed the high likelihood of a favorable outcome (a reduction in LHISI) when each of the 3 test drugs versus glucose solution was administered; the highest RR and OR were also found in the use of remaxol. Estimation of costs and the number of patients to be treated (NPBT) in order to avoid a case of none LHLIS reduction could reveal the highest efficacy of remaxol. Conclusion. The test agents (reamberine, remaxol, and ademethionine) are effective in treating tuberculosis patients with drug-induced liver injury. The administration of remaxol demonstrated the highest positive effect (as estimated by LHISI) in terms of both RR and NPBT.

drug-induced hepatotoxicity, antituberculosis drugs, laboratory severity index, remaxol, ademethionine, reamberine