Efficacy of Tuberculosis Chemotherapy Containing Thioureidoiminomethylpyridinium Perchlorate in Patients with Comorbidities

The objective: to evaluate the efficacy of incorporating thioureidoiminomethylpyridinium perchlorate (Tpp) into the chemotherapy regimen for multidrug-resistant, pre-extensively drug-resistant and extensively drug-resistant (MDR, pre-XDR, and XDR) tuberculosis (TB) in patients with comorbidities.

Materials and Methods. This retrospective study included 108 patients aged 18 years and older who received Tpp during the intensive phase of chemotherapy for pulmonary MDR-TB, pre-XDR, and XDR-TB. The second group consisted of 63 patients who started the intensive phase of anti-tuberculosis therapy without the inclusion of thioureidoiminomethylpyridinium perchlorate. Treatment efficacy was evaluated at 2, 4, and 6 months after initiation of chemotherapy based on three criteria: resolution of clinical symptoms, positive radiological dynamics, and cessation of bacterial excretion. Comorbidity was assessed using the Charlson Comorbidity Index.

Results. Subgroup analysis based on the comorbidity index demonstrated that TB treatment efficacy assessed by standard criteria depended on the index value. Patients with a higher comorbidity index score achieved clinical improvement at a later stage. Persistent bacterial excretion was typical for patients with multimorbidity, substance and alcohol use, as well as diabetes mellitus.

Conclusion. Evaluating the efficacy of TB drugs in patients with comorbidities remains a challenging task; therefore, it is essential to predict potential drug-to-drug interaction. This study investigated the specific aspects of using thioureidoiminomethylpyridinium perchlorate for TB treatment in this complex patient population. While this drug is already successfully used in real-world clinical practice, the data obtained in this study further demonstrate high efficacy of Tpp-containing regimens, even in the presence of comorbidities.

1. Drapkina O.M., Kontsevaya A.V., Kalinina A.M., Avdeev S.N., et.al. Comorbidity of patients with noncommunicable diseases in general practice. Eurasian guidelines. Cardiovascular Therapy and Prevention. 2024;23(3):3996. (In Russ.) https://doi.org/10.15829/1728-8800-2024-3996. EDN: AVZLPJ.

2. Ershova E.S., Turik A.L., Pavlova M.V., Revjakin E.A. The effectiveness and the safety of combined tuberculosis treatment regimens using the drug perchlozon. Methods of forecasting, prevention and elimination of adverse events. Tuberculosis and socially significant diseases. 2021;9(4):43-53. (In Russ.) https://doi.org/10.54921/2413-0346-2021-12-4-43-53.

3. Moiseeva M.V., Mordyk A.V., Bagisheva N.V., et.al. A co-morbid patient of a phthisiologist, pulmonologist and cardiologist: focus on quality of life. Tuberculosis and Lung Diseases. 2022;100(6):32-37. (In Russ.) https://doi.org/10.21292/2075-1230-2022-100-6-32-37.

4. Ovsyankina ES, Panova LV, Zakharova IN, Piskunova OA. Comorbid conditions in phthisiology: The basis of interdisciplinary collaboration between pediatricians and phthisiologists (literature review and commentaries). Meditsinskiy sovet = Medical Council. 2024;(19):178-186. (In Russ.) https://doi.org/10.21518/ms2024-412.

5. Starshinova A.A., Belyaeva E.N., Kudryavtsev I.V., et.al. Features of the pathogen and efficacy of drug-resistant tuberculosis treatment. Translational Medicine. 2024;11(5):398-406. https://doi.org/10.18705/2311-4495-2024-11-5-398-406.

6. Strygin A.V., Klyausov A.S., Dotsenko A.M., Strygina A.O., Morkovin E.I. Effects of perchlozon and antibodies against human gamma-interferon and CD4 glycoprotein on the immune system of HIV-infected patients with associated pulmonary tuberculosis. Vestnik Volgogradskogo Gosudarstvennogo Meditsinskogo Universiteta. 2017; vol. 14 no.2, pp. 42-46. (In Russ.) https://doi.org/10.19163/1994-9480-2017-2(62)-42-46.

7. Khromova P.A., Sinkov V.V., Savilov E.D. Personalized approach as a basis for the future diagnosis of tuberculosis (Literature Review). Acta Biomedica Scientifica. 2019;4(3):127-137. (In Russ.) https://doi.org/10.29413/ABS.2019-4.3.17.

8. Shuvalova E.V., Panteleev A.M., Daynovets A.V., Udaltsova E.N. Safety assessment of the use of thioureidoiminomethylpyridinium perchlorate (Perchlozone) in the treatment of drug-resistant tuberculosis in patients with HIV infection. Infektsionnyebolezni: novosti, mneniya, obuchenie 2023; 12 (1): 69–74. DOI: https://doi.org/10.33029/2305-3496-2023-12-1-69-74. (in Russ.)

9. Global tuberculosis report 2022. Geneva: World Health Organization; 2022. Available at: https://iris.who.int/handle/10665/363752 [Accessed 27.09.2025].

10. Verboven L., Calders T., Callens S., Black J., Maartens G., Dooley K.E., Potgieter S., Warren R.M., Laukens K., Van Rie A. A treatment recommender clinical decision support system for personalized medicine: method development and proof-of-concept for drug resistant tuberculosis // BMC Med Inform Decis Mak. – 2022. – Т. 22, № 1. – Р. 56. https://doi.org/10.1186/s12911-022-01790-0.