Abstract
PurposeTo evaluate the efficacy and safety of adjunctive corticosteroids in the treatment of patients with tuberculous pleurisy.MethodsThe PubMed, Cochrane, Medline, Embase, Web of Science and Chinese National Knowledge Infrastructure were searched. Clinical trials of corticosteroids compared with control were eligible for inclusion.ResultsTen studies (6 randomized controlled trials [RCTs] and 4 non-RCTs) with 957 participants met the inclusion criteria. Compared to the controls (placebos or non-steroids), adjunctive corticosteroid use reduced the risk of residual pleural fluid after 4 weeks and the number of days to symptom improvement; however, there was no convincing evidence to support the positive effects of corticosteroids over the long term (8 weeks) on residual pleural fluid, pleural thickening, or pleural adhesions, and there was no statistical difference between the corticosteroid group and control group with respect to 7-days relief of the clinical symptoms or death from any cause. In addition, more adverse events were observed in patients who received corticosteroids than in those in the control group.ConclusionsOur results suggest that adjunctive corticosteroid use did not improve long-term efficacy and might induce more adverse events, although the risk of residual pleural fluid at 4 weeks and the number of days to symptom improvement were reduced.
Highlights
Tuberculosis (TB) is a serious infectious disease that results in 2.0 million deaths per year [1]
Our study showed that corticosteroids did not appear to provide statistically significant benefits for reducing residual pleural effusion after 8.0 weeks in the treatment of www.impactjournals.com/oncotarget tuberculous pleurisy (RR = 0.47, 95% Confidence interval (CI): 0.22–1.03, P = 0.06) (Figure 3)
The first related Randomized controlled trial (RCT) conducted by Lee et al [20], 40 patients with tuberculous pleurisy showed that corticosteroid administration could relieve the clinical symptoms and decrease pleural effusion (p < 0.05) compared to those in the placebo group, but their study failed to confirm whether corticosteroid use reduced pleural thickening; a non-RCT conducted by Mansour et al [10], 190 patients with tuberculous pleural effusion showed that the results were no longer statistically significant after 6.0 months and they concluded that corticosteroid therapy was unnecessary in the management of tuberculous pleural effusion
Summary
Tuberculosis (TB) is a serious infectious disease that results in 2.0 million deaths per year [1]. Tuberculous pleurisy is common in extrapulmonary TB [3] and accounts for ~4.0% of all TB cases in western countries and ~20% of all TB cases in South Africa [4,5,6]. Despite 6.0–9.0 months of anti-TB drug treatment, tuberculous pleurisy might still result in pleural fibrosis, calcification, and thickening. To prevent these complications, corticosteroids are frequently used in addition to conventional anti-TB drugs. Www.impactjournals.com/oncotarget a non-RCT conducted by Mansour et al [10] showed that the difference was not statistically significant after 6 months; the effect of adjunctive corticosteroids on tuberculous pleural effusion remains uncertain and controversial
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