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Aims  The aim of this study is to evaluate the potential association between  N ‐acetyltransferase type 2 ( NAT2 ) polymorphisms and drug‐induced liver injury during anti‐TB treatment (AT‐DILI).    Methods  We conducted a systematic review and performed a meta‐analysis to clarify the role of  NAT2  polymorphism in AT‐DILI. PubMed, Medline and EMBASE databases were searched for studies published in English to December 31, 2017, on the association between the  NAT2  polymorphism and AT‐DILI risk. Outcomes were pooled with random‐effects meta‐analysis. Details were registered in the PROSPERO register (number: CRD42016051722).    Results  Thirty‐seven studies involving 1527 cases and 7184 controls were included in this meta‐analysis. The overall odds ratio (OR) of AT‐DILI associated with  NAT2  slow acetylator phenotype was 3.15 (95% CI 2.58–3.84,  I  2  = 51.3%,  P  = 0.000). The OR varied between different ethnic populations, ranging from 6.42 (95% CI 2.41–17.10,  I  2  = 2.3%) for the West Asian population to 2.32 (95% CI 0.58–9.24,  I  2  = 80.3%) for the European population. Within the slow  NAT2  genotype, variation was also observed;  NAT2*6/*7  was associated with the highest risk of AT‐DILI (OR = 1.68, 95% CI 1.09–2.59) compared to the other slow  NAT2  acetylators combined.    Conclusions   NAT2  slow acetylation was observed to increase the risk of AT‐DILI in tuberculosis patients. Our results support the hypothesis that the slow  NAT2  genotype is a risk factor for AT‐DILI.

The association between the NAT2 genetic polymorphisms and risk of DILI during anti‐TB treatment: a systematic review and meta‐analysis