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Corticosteroids for tuberculous pleurisyEngel ME, Matchaba PT, Volmink J
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SummaryNo clear evidence that corticosteroids are effective for tuberculousTuberculous pleural effusion results from tuberculous infection of the membrane covering of the lungs. This results in a build up of fluid around the lung that impairs breathing and may lead to restriction of lung function in the long term. Some clinicians believe that corticosteroids used in combination with antituberculous drugs can help to prevent these complications. We found no clear evidence supporting the use of corticosteroids in people with tuberculous pleural effusion, regardless of HIV status. However, only one trial evaluated the balance between benefit and harm of corticosteroids in people infected with HIV.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
January 24. 2000 AbstractBackgroundCorticosteroids used in addition to antituberculous therapy have been reported to benefit people with tuberculous pleurisy. However, research findings are inconsistent, raising doubt as to whether such treatment is worthwhile. Concern also exists regarding the potential adverse effects of corticosteroids, especially in HIV-positive people. ObjectivesTo evaluate the effects of adding corticosteroids to drug regimens for tuberculous pleural effusion. Search strategyIn May 2007, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2007, Issue 2), MEDLINE, EMBASE, LILACS, Current Controlled Trials, and reference lists of articles. Selection criteriaRandomized and quasi-randomized controlled trials comparing any corticosteroid with no treatment, placebo, or other active treatment (both groups should receive the same antituberculous drug regimen) in people diagnosed with tuberculous pleurisy. Data collection and analysisTwo authors independently assessed trial methodological quality and extracted data. Data were analysed using relative risks (RR) and mean difference (MD) with 95% confidence intervals (CI). The fixed-effect model was applied in the absence of statistically significant heterogeneity. Main resultsSix trials with 633 participants met the inclusion criteria; one trial included only HIV-positive people. Compared to control, corticosteroid use was associated with less residual pleural fluid at four weeks (RR 0.76, 95% CI 0.62 to 0.94; 394 participants, 3 trials) and reduced pleural thickening (RR 0.69, 95% CI 0.51 to 0.94; 309 participants, 4 trials). We found no evidence of an effect of corticosteroids on death from any cause (194 participants, 1 trial), respiratory function (191 participants, 2 trials), residual pleural fluid at eight weeks (399 participants, 4 trials), or pleural adhesions (123 participants, 2 trials). Although discontinuation of treatment due to adverse events was more frequent in participants receiving corticosteroids than placebo (RR 2.80, 95% CI 1.12 to 6.98; 586 participants, 6 trials), the effects were generally mild. The risk of Kaposi sarcoma may be increased in HIV-positive people receiving corticosteroids (RR 13.00, 95% CI 0.74 to 227.63; 194 participants, 1 trial). Authors' conclusionsThere are insufficient data to support evidence-based recommendations regarding the use of adjunctive corticosteroids in people with tuberculous pleurisy. Randomized controlled trials that are sufficiently powered to evaluate the effects of corticosteroids on both morbidity and mortality are needed. The effects of corticosteroids on HIV-related complications, such as Kaposi sarcoma, should be assessed in people co-infected with HIV. |