{
  "abstract": "Background: Cycloserine (Cs) is essential in bedaquiline (Bdq)/delamanid (Dlm)-based regimens for drug-resistant tuberculosis (DR-TB), but real-world evidence on neuropsychiatric/central nervous system and peripheral nervous system adverse events (AEs) during Cs-containing treatment remains limited.\n\nMethods: A multicenter retrospective cohort study analyzed 2359 adults with multidrug-resistant or rifampicin-resistant tuberculosis (MDR/RR-TB) patients in China (2018–2023) treated with Cs alongside Bdq, Dlm, or conventional therapy. Neuropsychiatric/CNS and peripheral nervous system AEs were assessed using the Symptom Checklist-90 and graded per Division of Acquired Immunodeficiency Syndrome v2.1. Multivariable logistic regression and sensitivity analyzes were used to examine factors associated with these AEs.\n\nResults: A total of 2359 participants were included in this study. The overall incidence of neuropsychiatric/CNS or peripheral nervous system AEs during Cs-containing treatment was 5.3%, with higher frequency in Dlm-based regimens (8.2%) compared to Bdq (4.1%) and conventional therapy (5.2%). Psychiatric/CNS events occurred in 3.4% of patients, and peripheral neuropathy (PN) occurred in 1.9%. Among the 125 events, the most common adverse events were PN at 36.0%, followed by insomnia at 16.8% and headache at 9.6%. Serious adverse events, defined as grade 3 or higher, accounted for 15.2% of all cases, with the highest proportion observed in the Dlm cohort at 23.4%. Multivariable analysis showed that the Dlm-containing regimen was associated with higher odds of overall AEs (adjusted odds ratio: 1.71, 95% confidence interval: 1.12–2.60), as were female sex (1.56, 1.07–2.27), BMI < 18.5 kg/m² (1.51, 1.03–2.23), and retreatment status (1.75, 1.01–3.05). In sensitivity analyzes, no association was observed between the Dlm-containing regimen and psychiatric/CNS events (0.95, 0.54–1.68), whereas an association was observed for PN (3.43, 1.76–6.69).\n\nConclusion: In this real-world observational study, neuropsychiatric/CNS and peripheral nervous system AEs were observed during Cs-containing treatment, with differences across treatment cohorts. These findings support careful clinical monitoring but cannot establish the causal effects of Cs, Dlm, or any individual treatment regimen.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China",
    "Clinical Center on Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, 101149, China"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Ziwen Li"
    },
    {
      "affs": [
        1
      ],
      "name": "Yang Liu"
    },
    {
      "affs": [
        1
      ],
      "name": "Zhili Li"
    },
    {
      "affs": [
        1
      ],
      "name": "Yuxian Sun"
    },
    {
      "affs": [
        1
      ],
      "name": "Wei Shu"
    },
    {
      "affs": [
        1
      ],
      "name": "Lijie Zhang"
    },
    {
      "affs": [
        1
      ],
      "name": "Jian Du"
    },
    {
      "affs": [
        1
      ],
      "name": "Yuhong Liu"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Liang Li"
    },
    {
      "affs": [
        1
      ],
      "name": "Leiwen Fu"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/axfpmxr3y92gc.bib",
  "cited_by": 0,
  "doi": "10.1016/j.imj.2026.100292",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13735233/",
  "id": "axfpmxr3y92gc",
  "issns": [
    "2097-0684",
    "2772-431X"
  ],
  "landing_url": "https://doi.org/10.1016/j.imj.2026.100292",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Article"
    ],
    [
      "openalex",
      "2725|Tuberculosis Research and Epidemiology"
    ]
  ],
  "openalex": "W7221073492",
  "pdf_url": null,
  "pmcid": "PMC13735233",
  "pmid": "42990789",
  "published": "2026-10-09",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/axfpmxr3y92gc.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T12:20:57Z",
      "native_id": "PMC13735233",
      "source": "pmc",
      "url": "https://doi.org/10.1016/j.imj.2026.100292"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2725|Tuberculosis Research and Epidemiology",
      "subfield": "infectious-disease"
    }
  ],
  "title": "Neuropsychiatric effects of cycloserine with bedaquiline, delamanid, and conventional therapy in drug-resistant tuberculosis: a multicenter retrospective cohort study from China",
  "title_text": "Neuropsychiatric effects of cycloserine with bedaquiline, delamanid, and conventional therapy in drug-resistant tuberculosis: a multicenter retrospective cohort study from China",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T12:20:57Z",
  "url": "https://research.draconitic.com/paper/axfpmxr3y92gc",
  "venue": "Infectious Medicine",
  "versions": []
}