Corticosteroids for tuberculous pleurisy

Abstract

Background Corticosteroids used in addition to antituberculous therapy have been reported to benefit people with tuberculous pleurisy. However, research findings are inconsistent and raise doubt as to whether such treatment is worthwhile. There is also concern regarding the potential adverse effects of corticosteroids, especially in HIV‐positive people. Objectives To evaluate the effects of adding corticosteroids to drug regimens for tuberculous pleural effusion. Search methods In April 2016, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (the Cochrane Library), MEDLINE, Embase, LILACS, Current Controlled Trials, and the reference lists of articles identified by the literature search. Selection criteria Randomized controlled trials (RCTs) and quasi‐RCTs that compared any corticosteroid with no treatment, placebo, or other active treatment (both groups should have received the same antituberculous drug regimen) in people diagnosed with tuberculous pleurisy. Data collection and analysis Two review authors independently screened the search results, extracted data from the included trials, and assessed trial methodological quality using the Cochrane 'Risk of bias' tool. We analysed the data using risk ratios (RR) with 95% confidence intervals (CIs). We applied the fixed‐effect model in the absence of statistically significant heterogeneity. Main results Six trials with 590 participants met the inclusion criteria, which were conducted in Asia (three trials), Africa (two trials), and Europe (one trial). Two trials were in HIV‐negative people, one trial was in HIV‐positive people, and three trials did not report HIV status. Corticosteroids may reduce the time to resolution of pleural effusion. Risk of residual pleural effusion on chest X‐ray was reduced by 45% at eight weeks (RR 0.54, 95% CI 0.37 to 0.78; 237 participants, 2 trials, low certainty evidence ), and 65% at 24 weeks (RR 0.35, 95% CI 0.18 to 0.66; 237 participants, 2 trials, low certainty evidence ). Compared with control, corticosteroids may reduce the risk of having pleural changes (such as pleural thickening or pleural adhesions), on chest X‐ray at the end of follow‐up by almost one third (RR 0.72, 95% CI 0.57 to 0.92; 393 participants, 5 trials, low certainty evidence ), which translates to an absolute risk reduction of 16%. One trial reported deaths in people that were HIV‐positive, with no obvious difference between the groups; the trial authors' analysis suggests that the deaths observed in this trial were related to HIV disease rather than pleural TB (RR 0.91, 95% CI 0.64 to 1.31; 197 participants, 1 trial). We found limited data on long‐term functional respiratory impairment on 187 people in two trials, which...

Tuberculous pleural effusion

“…As yet, there is no definitive evidence of benefit of corticosteroids in the management of tuberculous effusions. The evidence suggests a possible reduction of the risk of residual pleural effusion by 45% at 8 weeks and 65% at 24 weeks, and a possible reduction of the risk of pleural adhesions and thickening by 16%; however, this was accompanied by a trend towards a higher incidence of adverse events, including Kaposi sarcoma in HIV‐positive people . Considering that there is no high‐quality evidence linking residual pleural effusion and thickening to adverse clinical outcomes, the current recommendation is to avoid corticosteroids.…”

Identifying tuberculous pleural effusion using artificial intelligence machine learning algorithms

“…Tuberculous pleurisy is a common disease that causes pleural effusion. In 2014, approximately 1.5 million tuberculosis patients died worldwide [1]. Accurate diagnosis and timely treatment are vital.…”

Beware of Pleural Thickening and Calcification: An Enlightenment from a Case of Tuberculous Pleurisy

“…Although this treatment strategy can significantly reduce the number of pleural effusions in a short amount of time, significantly more adverse reactions have occurred in patients receiving glucocorticoids treatment than in those not using glucocorticoids, and there is no conclusive evidence regarding their effect on pleural thickening; Thus, their clinical application remains to be further explored. 15 …”