Drug-induced liver injury (DILI) is a frequent and serious complication of first-line antitubercular therapy (ATT), with significant morbidity and mortality. Reintroduction of ATT post-DILI is essential due to the limited efficacy and higher toxicity of second-line drugs. This narrative review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses principles to evaluate existing evidence on ATT reintroduction protocols, including concomitant, sequential, and incremental approaches. A comprehensive search of PubMed up to August 2024 identified eight relevant studies comprising randomized controlled trials, cohort studies, and a systematic review. Across studies, recurrence rates ranged from 6.9% to 18%, with pyrazinamide most frequently implicated. Incremental regimens demonstrated a trend toward lower recurrence rates, although statistical significance was inconsistent. Sequential and concomitant approaches showed comparable outcomes. Patient-related factors such as hypoalbuminemia, low body mass index, female sex, and elevated bilirubin levels were associated with increased risk of recurrence. Current evidence is limited, and individualized treatment plans based on clinical judgment remain necessary. There is a clear need for well-designed studies to establish safe and effective reintroduction protocols.
Tewari et al. (Fri,) studied this question.