Evaluation of Steroid Therapy in Tuberculous Pleurisy: A Prospective, randomized study

Bang, Jei So; Kim, Myong Sik; Kwak, Seung Min; Cho, Chul Ho

doi:10.4046/trd.1997.44.1.52

Cited by 9 publications

(39 citation statements)

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“…One review author (JY) extracted data from Bang 1997 and Lee 1999 as both trial reports were in Korean. We resolved disagreements through discussion and contacted the corresponding trial author in the case of unclear or missing data.…”

Section: Methodsmentioning

confidence: 99%

“… 1 Downgraded by one for risk of bias: of the four trials that reported this outcome, we excluded two trials from the final analysis due to high risk of selection bias, after a subgroup analysis suggested the pooled estimate including these studies could be misleading (Bang 1997; Lee 1999). We judged this to be our best estimate of effect.…”

Section: Summary Of Findings For the Main Comparisonmentioning

confidence: 99%

“…One trial included HIV-positive people, Elliott 2004, and this trial contributed most of the participants in the meta-analysis. When making recommendations relating to the use of corticosteroids for pleural TB in children or in HIV-negative adults, guideline panels may wish to consider downgrading for indirectness. 5 Downgraded by one for serious risk of bias: we assessed two trials as at high risk of bias for randomization method (Bang 1997; Lee 1999), and the other three trials were at unclear risk of bias (Galarza 1995; Lee 1988; Wyser 1996). Only Wyser 1996 reported that outcome assessors were blinded to the treatment allocation.…”

Section: Summary Of Findings For the Main Comparisonmentioning

confidence: 99%

“… 5 Downgraded by one for serious risk of bias: we assessed two trials as at high risk of bias for randomization method (Bang 1997; Lee 1999), and the other three trials were at unclear risk of bias (Galarza 1995; Lee 1988; Wyser 1996). Only Wyser 1996 reported that outcome assessors were blinded to the treatment allocation.…”

Section: Summary Of Findings For the Main Comparisonmentioning

confidence: 99%

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Corticosteroids for tuberculous pleurisy

Ryan

Yoo

Darsini

2017

Cochrane Database of Systematic Reviews

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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...

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Section: Methodsmentioning

confidence: 99%

Section: Summary Of Findings For the Main Comparisonmentioning

confidence: 99%

Section: Summary Of Findings For the Main Comparisonmentioning

confidence: 99%

Section: Summary Of Findings For the Main Comparisonmentioning

confidence: 99%

See 2 more Smart Citations

Corticosteroids for tuberculous pleurisy

Ryan

Yoo

Darsini

2017

Cochrane Database of Systematic Reviews

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“…In a Cochrane systematic review, Engel et al 20 found that corticosteroid use had no appreciable effect on the resolution of pleural effusion at eight weeks and development of pleural adhesions. However , two small trials 21,22 found that corticosteroids significantly decreased the duration of clinical symptoms by about 4.3 days .Unexpectedly, Engel et al 20 found that corticosteroids significantly reduced the risk of pleural thickening by about 31% (Figure). It is worth noting that two of the four trials that assessed pleural thickening had also compared the pulmonary functions by forced vital capacity at the end of treatment between the corticosteroid and control arms 23,24 .…”

Section: Corticosteroids In Tubercular Pleural Effusionmentioning

confidence: 99%