Predictors of the Effectiveness of Psychological Support in Addition to the Base Treatment in Pulmonary Tuberculosis

The aim of the study was to investigate the effect on the psycho-emotional state and adherence to treatment in patients with pulmonary tuberculosis of remaxol inclusion in the accompanying therapy regimens.

Material and methods. The data from 326 patients (252 men and 74 women) with various forms of pulmonary tuberculosis treated at the Regional Clinical Tuberculosis Dispensary were analyzed; the average age of patients was 41.3±1.6 years. A low level of adherence to treatment, as well as clinical and laboratory signs of grade I hepatotoxicity were revealed in patients receiving a course of etiotropic therapy in the main group (N=72). In this regard, in addition to the psychological support for the main course of treatment, accompanying therapy was prescribed: remaxol 400 ml intravenous drip every other day (course No. 5), after-wards — 1 time a week (course No. 4). Patients in the comparison group (N=254) received standard treatment. In addition to the standard examination, the cytokine profile (the level of IL-1β, 4, 6), TNF-α and IFN-γ) was determined in dynamics according to the indications in patients. The level of adherence to the treatment was also determined in dynamics through testing according to the original methodology.

Results. The study revealed that the inclusion of remaxol in the treatment regimens facilitated more pronounced positive dynamics in clinical and laboratory data compared with the standard regimen: a decrease in signs of hepatotoxicosis and a tendency towards improvement in cytokine profile parameters. This contributed to maintaining the etiotropic therapy regimen and improving the well-being of patients, which, in turn, increased the level of adherence and therefore the effectiveness of treatment in patients.

Conclusions. The combination of positive effects of remaxol use in patients with pulmonary tuberculosis contributes to an increase in their psycho-emotional state and thereby increases adherence to treatment and its effectiveness. 

1. Vasil'eva I. A., Samojlova A. G., Zimina V. N., Lovacheva O. V., Abramchenko A. V. Khimioterapiya tuberkuleza v Rossii — istoriya prodolzhaetsya Tuberkulez i Bolezni Legkikh. 2023; 101 (2): 8–12. doi: http://doi.org/10.58838/2075-1230-2023-101-2-8-12. (in Russian)]

2. Zolotova N. V., Baranova G. V., Strel'tsov V.V., i dr. Osobennosti perenosimosti protivotuberkuleznoj khimioterapii s uchetom psikhologicheskogo statusa patsientov. Tuberkulez i Bolezni Legkikh. 2017; 4: 15–19. (in Russian)]

3. Strel'tsov V.V., Zolotova N. V. Psikhologicheskoe soprovozhdenie bol'nogo tuberkulezom legkikh: analiz sluchaya. Konsul'tativnaya Psikhologiya i Psikhoterapiya. 2019; 27 (1): 102–118 doi: http://doi.org/10.17759/cpp.2019270107. (in Russian)]

4. Alipanah N., Jarlsberg L., Miller C., Linh N.N., Falzon D., Jaramillo E., Nahid P. Adherence interventions and outcomes of tuberculosis treatment: A systematic review and meta-analysis of trials and observational studies. PLoS Med. 2018 Jul 3; 15 (7): e1002595. doi: 10.1371/journal.pmed.1002595.eCollection 2018 Jul.

5. Global tuberculosis report 2021. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.

6. Prikaz MZ RF ot 29.12.2014 g. № 951 «Ob utverzhdenii metodicheskikh rekomendatsij po sovershenstvovanijyu diagnostiki i lecheniya tuberkuleza organov dykhaniya» Moscow: 215. (in Russian)]

7. Dolgushina A. I., Volchegorskij I. A., Novoselov P. N., Ushkareva E. V., Olevskaya E. R., Kuznetsova A. S. Gepatotoksichnost' protivotuberkuleznykh preparatov. Eksperimental'naya i Klinicheskaya Gastroenterologiya. 2018; 156 (8): 116–124. doi: http://doi.org/10.31146/1682–8658-ecg-156-8-116-124. (in Russian)]

8. Yew W.W., Chang K.C., Chan D.P. Oxidative stress and first-line antituberculosis drug-induced hepatotoxicity Antimicrob Agents Chemother. 2018 Jul 27; 62 (8): e02637-17. doi: 10.1128/AAC.02637-17. Print 2018 Aug

9. Il'chenko L. Jyu., Okovityj S.V. Remaksol: mekhanizmy dejstviya i primenenie v klinicheskoj praktike. Arkhiv Vnutrennej Meditsiny. Spetsial'nyj Vypusk. 2016; 1–14. (in Russian)

10. Volchegorskij I.A., Novoselov P.N., Ushkareva E.V. Vliyanie remaksola na effektivnost' standartnogo lecheniya bol'nykh infil'trativnym tuberkulezom legkikh. Terapevticheskij Arkhiv. 2016; 3: 73–78. (in Russian)]

11. Shurygin A. A., Alekseeva Jyu. A. Effektivnost' primeneniya remaksola v terapii porazhenij pecheni, vyzvannykh priemom protivotuberkuleznykh preparatov. Ftiziatriya i Pul'monologiya. 2016; 1: 51–53. (in Russian)]

12. Patent na izobretenie Rossii RU № 2611398 «Sposob povysheniya effektivnosti lecheniya bol'nykh tuberkulezom» 21.02.2017. RU № 2611398. (in Russian)]

13. Boni F.G., Hamdi I., Koundi L.M., Shrestha K., Xie J. Cytokine storm in tuberculosis and IL-6 involvement Infect Genet Evol. 2022 Jan; 97: 105166. doi: 10.1016/j.meegid.2021.105166. Epub 2021 Nov 30.

14. Tarasova L. G., Strel'tsova E. N., Kantemirova B. I., Galimzyanov Kh.M., Kasimova N. B. Tsitokinovyj profil' u bol'nykh tuberkulezom legkikh. Astrakhanskij Meditsinskij Zhurnaljyu. 2016; 11 (2): 84–92. (in Russian)]

15. Mezentseva M.V., Stakhanov V.A., Zakharova M.V., Zotova I.F.,Tregubova M.I., Shapoval I.M. Tsitokiny kak markery razvitiya infil'trativnogo tuberkuleza legkikh. Infektsii i Immunitet. 2011; 1 (4): 367–372. (in Russian)]