Systematic review and meta-analysis of adjunctive corticosteroids in the treatment of tuberculous pericarditis

作者：George I A^*; Thomas B; Sadhu J S

来源：International Journal of Tuberculosis and Lung Disease, 2018, 22(5): 551-+.

DOI：10.5588/ijtld.17.0341

• meta-analysis
• tuberculosis
• pericarditis
• steroids
• mortality

SETTING: Tuberculosis (TB) is the most common cause of pericarditis worldwide and carries a high mortality, even with effective anti-tuberculosis treatment. In the light of a randomized control trial in 2014, the American Thoracic Society and the Centers for Disease Control and Prevention/Infectious Diseases Society of America recently revised their recommendations against the routine use of adjunctive corticosteroids.
OBJECTIVE : To evaluate the strength of evidence that resulted in this reversal of the guideline recommendations on the use of adjunctive corticosteroids in TB pericarditis by a meta-analysis, followed by a sensitivity analysis.
DESIGN: Systematic review and meta-analysis of published randomized control trials.
RESULTS : We identified five randomized control trials that met the eligibility criteria. Combining the results of the included trials, there was no overall mortality benefit from adjunctive corticosteroids (a random-effects model yielded a non-significant relative risk of 0.66 and 95% CI of 0.35-1.27). A sensitivity analysis further confirmed that the results of the meta-analysis were robust.
CONCLUSION: Routine addition of oral corticosteroids to standard anti-tuberculosis treatment does not reduce mortality among patients with TB pericarditis.

• 出版日期2018-5