Intrathecal therapy for tuberculous meningitis: propensity-matched cohort study

Abstract

ObjectiveThe study aimed to determine the safety and efficacy of intrathecally administered isoniazid (INH) and prednisolone in addition to systemic anti-TB therapy and compare it with systemic anti-TB therapy alone in adult patients with tuberculous meningitis (TBM). Methods In this retrospective study, patients were categorized into two groups: Group A patients received systematic anti-TB therapy alone, Group B patients received IT INH (50 mg) and prednisolone (25 mg) twice a week together with the same standard systemic anti-TB therapy as Group A, in addition to the standard systemic anti-TB therapy. Functional outcomes were compared between the two groups in a prosperity-matched cohort using propensity score matching (PSM) method. Results A total of 198 patients with TBM were enrolled. After PSM, 30 patients from each group were analyzed, so that there was no significant difference in the characteristics of the two groups. Mortality at follow-up was significantly lower among patients receiving additional IT therapy (4/30, 13.3%) compared with matched patients receiving systemic anti-TB therapy alone (11/30, 36.7%, P value = 0.037). Conclusions In this propensity score-matched cohort, the addition of IT INH and prednisolone to systemic anti-TB therapy could be effective for the better outcome among adult TBM patients. Further large-scale, prospective, and randomized controlled trials are warranted to the best timing and indication of IT therapy.

Comprehensive Therapeutic Approaches to Tuberculous Meningitis: Pharmacokinetics, Combined Dosing, and Advanced Intrathecal Therapies

“…Furthermore, the OR for poor outcomes was 0.386 (95% CI: 0.136–1.094; p = 0.073), suggesting a trend towards improved outcomes in the IT therapy group, although statistical significance was not reached. These findings underscore the potential benefit of incorporating IT therapy with systemic anti-TB in the management of TBM, particularly in reducing mortality rates [ 124 ].…”

“…Comparing IT-INH alongside systemic therapy vs. systemic INH alone: A propensity-matched cohort study compared IT-INH alongside systemic therapy to systemic anti-TB therapy alone, highlighting the advantages of the concomitant treatment approach. This study showed that integrating IT therapy with systemic anti-TB therapy was more effective than systemic therapy alone in patients with TBM over long-term follow-up [ 124 ]. In the overall cohort, there were 36 patients in the IT group and 162 patients in the systemic therapy group.…”

“…These events necessitate careful consideration and monitoring. Comparing concurrent administration of IT/IVT anti-TB alongside systemic therapy of anti-TB in the treatment of TBM, there is a lack of data, although one study compared the concomitant IT INH versus systemic alone and showed superior concomitant therapy [ 124 ].…”

Efficacy of Intrathecal Isoniazid and Steroid Therapy in Refractory Tuberculous Meningitis

“…The combination of intrathecal administration of isoniazid and prednisolone has been reported to be associated with a reduced mortality rate ( 7 ), although little is known about its efficacy. Intrathecal treatment for tuberculous meningitis is not mentioned in any of the major guidelines, and treatments are not yet standardized.…”

Clinical research progress on intrathecal glucocorticoids in the treatment of infections: A review

“…In patients treated with intrathecal hydrocortisone, survival rates were much higher, disease duration was much shorter, coma and hospital stay were much shorter, and sequelae were much less severe. Li K [ 33 ] et al conducted a retrospective study on adult patients. Patients in Group A received only systemic antituberculosis treatment, while patients in Group B received twice-weekly intrathecal isoniazid (50 mg) and prednisolone (25 mg) in addition to systemic antituberculosis treatment.198 patients with TBM were included in a total of 60 cases for comparison through propensity score matching, with 30 cases in each group.…”