STEROIDS FOR TUBERCULOUS PLEURISY A Systematic Review and Meta-analysis of clinical trials

Background: Corticosteroids used in addition to anti-tuberculous therapy have been reported to benefit people with tuberculous pleurisy. However, research findings are not consistent, raising doubt as to whether such treatment is worthwhile. Concem also exists regarding the potential adverse effects of steroids, especially in HIV positive patients. An earlier Cochrane review summarized the existing evidence on the effects of steroids in people with tuberculous pleurisy. This review updates the evidence and, for the first time sheds light on the effects of steroids in patients with tuberculous pleurisy co-infected with HIV. Objectives: To examine the evidence from randomised controlled tri~ls conceming the effect of steroids in patients with tuberculosis of the pleura. Search strategy: The following databases were searched: Cochrane Infectious Diseases Group specialized trials register (October 2003), The Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2003), MEDLINE (1966 to October 2003), EMBASE (1980 to October 2003), LILACS (October 2003), U.S. NIH ClinicalTrials.gov (October 2003), and Current Controlled Trials (October 2003). In addition, Lists of references from review articles and primary studies were scanned for further studies Selection criteria: Randomised and quasi-randomised trials evaluating the effects of adjunctive corticosteroids in patients diagnosed with TB pleurisy were sought. Data collection & analysis: Two authors independently applied inclusion criteria,

[1]  R. Davies,et al.  The management of pleural space infections , 2004, Respirology.

[2]  D. Kontoyiannis,et al.  Glucocorticoids and invasive fungal infections , 2003, The Lancet.

[3]  Charles L Daley,et al.  American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. , 2003, American journal of respiratory and critical care medicine.

[4]  M. Goldbaum,et al.  Clinical and epidemiological features of AIDS/tuberculosis comorbidity. , 2003, Revista do Hospital das Clinicas.

[5]  P. Monini,et al.  Biology of Kaposi's sarcoma. , 2001, European journal of cancer.

[6]  J. Volmink,et al.  Steroids for treating tuberculous pleurisy. , 2000, The Cochrane database of systematic reviews.

[7]  S. Bilaçeroğlu,et al.  Prednisolone: a beneficial and safe adjunct to antituberculosis treatment? A randomized controlled trial. , 1999, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[8]  R. Morehead.  Tuberculosis of the pleura. , 1998, Southern medical journal.

[9]  D. Dooley,et al.  Adjunctive corticosteroid therapy for tuberculosis: a critical reappraisal of the literature. , 1997, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[10]  S. Sahn,et al.  Tuberculous pleurisy is more common in AIDS than in non-AIDS patients with tuberculosis. , 1997, Chest.

[11]  K. M. Murray,et al.  Corticosteroids in Tuberculosis , 1996, The Annals of pharmacotherapy.

[12]  F. Manresa,et al.  Randomised trial of corticosteroids in the treatment of tuberculous pleurisy. , 1995, Thorax.

[13]  W. Rom,et al.  Pleural tuberculosis and HIV infection. , 1994, Chest.

[14]  A. Elliott,et al.  Use of prednisolone in the treatment of HIV-positive tuberculosis patients. , 1992, The Quarterly journal of medicine.

[15]  K. M. Mathews,et al.  Epidemiology of extrapulmonary tuberculosis. A comparative analysis with pre-AIDS era. , 1991, Chest.

[16]  J. Bass,et al.  Tuberculous pleural effusion : twenty-year experience , 1991 .

[17]  R. Hayes,et al.  Impact of HIV on tuberculosis in Zambia: a cross sectional study. , 1990, BMJ.

[18]  A. Harries,et al.  Tuberculosis and human immunodeficiency virus infection in developing countries , 1990, The Lancet.

[19]  V. Utkin,et al.  [Effectiveness of antitubercular chemotherapy combined with corticosteroids and immunomodulators]. , 1990, Problemy tuberkuleza.

[20]  Starostenko Ev,et al.  Indications for the use of prednisolone in tuberculosis , 1989 .

[21]  E. V. Starostenko,et al.  [Indications for the use of prednisolone in tuberculosis]. , 1989, Problemy tuberkuleza.

[22]  Y. Tsai,et al.  Corticosteroids in the Treatment of Tuberculous Pleurisy: A Double-blind, Placebo-controlled, Randomized Study , 1988 .

[23]  B. Balbi,et al.  Tuberculous pleural effusions. Evidence for selective presence of PPD-specific T-lymphocytes at site of inflammation in the early phase of the infection. , 1987, The American review of respiratory disease.

[24]  S. Albelda,et al.  Tuberculous pleural effusions. , 1987, Chest.

[25]  P. Thompson,et al.  Rifampicin reduces effectiveness and bioavailability of prednisolone. , 1983, British medical journal.

[26]  M. Saavedra,et al.  [Clinical study of a new synthetic steroid in the treatment of pleural tuberculosis]. , 1973, Gaceta medica de Mexico.

[27]  Grewal Ks,et al.  A comparative study of therapeutic regimens with and without corticosteroids in the treatment of tuberculous pleural effusion. , 1969 .

[28]  R. Dixit,et al.  A comparative study of therapeutic regimens with and without corticosteroids in the treatment of tuberculous pleural effusion. , 1969, Journal of the Indian Medical Association.

[29]  Damany Sj,et al.  Treatment of pleural effusion with and without triamcinolone in addition to usual antituberculosis chemotherapy. , 1968 .

[30]  M. Borgia,et al.  [Controlled clinical trials of the use of a new anabolic agent in a Sanatorium]. , 1966, La Clinica terapeutica.

[31]  S. S. Yesikar,et al.  Role of intrapleural corticosteroids in tuberculous pleural effusion: a clinicotherapeutic trial of 50 cases. , 1965, Journal of the Indian Medical Association.

[32]  P. L. Tanzj,et al.  [On therapeutic use of corticosteroids in pleuro-pulmonary tuberculosis]. , 1965, Archivio di tisiologia e delle malattie dell'apparato respiratorio.

[33]  J. Mathur,et al.  TREATMENT OF TUBERCULOUS PLEURAL EFFUSION WITH LOCAL INSTILLATION OF HYDROCORTISONE. , 1965, Diseases of the chest.

[34]  N. Menon.  STEROID THERAPY IN TUBERCULOUS PLEURAL EFFUSION. , 1964, Tubercle.

[35]  H. Poppius,et al.  CORTISONE THERAPY FOR EXUDATIVE TUBERCULOUS PLEURISY IN THE LIGHT OF A FOLLOW-UP STUDY. , 1964, Acta tuberculosea et pneumologica Scandinavica.

[36]  J. Filler,et al.  PHYSIOLOGIC STUDIES OF THE SEQUELAE OF TUBERCULOUS PLEURAL EFFUSION IN CHILDREN TREATED WITH ANTIMICROBIAL DRUGS AND PREDNISONE. , 1963, The American review of respiratory disease.

[37]  J. Mathur,et al.  Intrapleural hydrocortisone in tuberculous pleural effusion. , 1960, Tubercle.

[38]  A. Coetzee,et al.  Antituberculous therapy combined with adrenal steroids in the treatment of pleural effusions: a controlled therapeutic trial. , 1960, Lancet.

[39]  S. Paley,et al.  Prednisone in the treatment of tuberculous pleural effusions. , 1959, American review of tuberculosis.

[40]  J. Aspin,et al.  Steroid-treated tuberculous pleural effusions. , 1958, The British journal of tuberculosis and diseases of the chest.

[41]  W. Mcdermott,et al.  Effects of adrenocorticotropic hormone and cortisone in patients with tuberculosis. , 1951, The Journal of clinical investigation.

[42]  U. Ludwigs.  Using Corticosteroids to Treat Tuberculous Pleurisy , 2022 .