OPA4 NAVIGATING DRUG RESISTANCE: TREATMENT OUTCOMES AND ADVERSE EFFECTS OF MDR/RR-TB IN KEDAH (2021–2025)

Mohd Khairil Ashraf Muhammad Fisa1¹, Arvindran Alaga¹ , Asyif Fairus Ahmad¹, Farrah Suraya Kamarudin^2,Noor Yusriza Suzane Mohd Yusoff¹
¹Respiratory Department, Hospital Sultanah Bahiyah, Alor Setar, Kedah
²Pharmacy Department, Hospital Sultanah Bahiyah, Alor Setar, Kedah

Background
MDR/RR-TB continues to pose significant challenges. While global guidelines are in place, real-world data on treatment outcomes and regimen tolerability at the regional level remain limited. This study aimed to describe patient profiles, treatment regimens, adverse effects, and outcomes among MDR/RR-TB cases in Kedah from 2021 to 2025.

Methods
A retrospective study was conducted involving 27 confirmed MDR/RR-TB patients in Kedah. Data were extracted on demographics, comorbidities, treatment regimens, side effects, and final outcomes from electronic medical records. Treatment types were based on WHO guidelines. Outcomes were classified as treatment completed, death, failure, loss to follow-up, or ongoing. Data were analysed using Fisher’s exact test to compare categorical variables due to the small sample size.

Results
The cohort had a mean age of 47 years (range 21–68), with 67% being male. Comorbidities were diabetes mellitus (41%) and smoking (41%). Among 18 evaluable cases (excluding those lost to follow-up or still undergoing treatment), 72% completed treatment, 22% died, and one experienced treatment failure. Adverse effects were reported in 63% of patients, with metabolic disturbances (44%) and ototoxicity (15%) being most prevalent. Four patients defaulted, and two absconded, indicating significant adherence challenges.

Injectable-based regimens were significantly associated with a higher frequency of adverse effects compared to all-oral regimens (93% vs. 55%, p=0.041). However, treatment completion rates did not differ significantly between the two groups (80% vs. 50%, p=0.56). These findings highlight the greater tolerability of all-oral regimens despite comparable efficacy in this cohort.

Conclusions
MDR/RR-TB management in Kedah shows higher treatment success compared to global data but is hindered by considerable rates of adverse effects and patient non-adherence. The shift towards safer, all-oral regimens, along with strengthened adherence support, may improve future outcomes. These findings offer valuable local insights to inform state-level TB control strategies and resource planning.