Impact of Yuehua Decoction on quality of life and safety in multidrug-resistant tuberculosis: a prospective cohort study using multivariable regression analysis

Background: Multidrug-resistant tuberculosis (MDR-TB) remains a major global health challenge, and prolonged chemotherapy often leads to substantial symptom burden and impaired health-related quality of life (HRQoL). Host-directed adjunctive therapies, including Traditional Chinese Medicine, have received growing interest; however, prospective clinical evidence on Yuehua Decoction remains limited. This study evaluated whether adjunctive Yuehua Decoction improves HRQoL and safety among patients receiving standardized MDR-TB treatment. Methods: We conducted a prospective, non-randomized cohort study enrolling adults with microbiologically confirmed MDR-TB. Patients received either standard MDR-TB chemotherapy alone (control group) or in combination with Yuehua Decoction (Yuehua group) based on treatment preference. The primary outcome was HRQoL at 6 months, assessed using the St. George's Respiratory Questionnaire (SGRQ). Between-group differences were analyzed using multivariable linear regression adjusting for baseline SGRQ and other clinically relevant covariates. Secondary outcomes included sputum culture conversion and treatment-related adverse events. Results: = 0.038), with no increase in serious adverse events. Conclusion: In this preliminary prospective cohort, adjunctive Yuehua Decoction was associated with improved HRQoL without increasing treatment-related toxicity among patients undergoing MDR-TB chemotherapy. These findings support Yuehua Decoction as a potential host-directed adjunct, but confirmation in larger randomized controlled trials is needed.