The Present Status of the Treatment of Tuberculosis of the Central Nervous System

Lepper, Mark H.; Spies, Harold W.

doi:10.1111/j.1749-6632.1963.tb16629.x

Cited by 40 publications

(6 citation statements)

References 33 publications

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“…Previous trials of adjunctive glucocorticoid therapy in patients with tuberculous pericarditis had relatively small samples (28 to 240 patients) and included few HIV-infected patients, and there was poor reporting of adverse events. 10,[29][30][31][32][33][34] Our trial included 1400 patients, a substantial number of whom (940 patients) had HIV infection. To our knowledge, M. indicus pranii immunotherapy has not been studied previously in this population.…”

Section: Discussionmentioning

confidence: 99%

Prednisolone andMycobacterium indicus praniiin Tuberculous Pericarditis

Ntsekhe

Bosch²,

Pandie³

et al. 2014

N Engl J Med

245

221

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Section: Discussionmentioning

confidence: 99%

Prednisolone andMycobacterium indicus praniiin Tuberculous Pericarditis

Ntsekhe

Bosch²,

Pandie³

et al. 2014

N Engl J Med

245

221

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“…The use of adjunctive corticosteroids to attenuate the inflammatory response in TBM may improve outcome by reducing the likelihood or severity of neurological complications. Over the past sixty years, a number of clinical studies have investigated this hypothesis using adjunctive corticosteroids in the treatment of TBM [2], [3], [4], [5], [6], [7], [8]. A decade ago a meta-analysis of all randomised controlled trials suggested that adjunctive corticosteroids reduced the risk of death in children but not in adults [9].…”

Section: Introductionmentioning

confidence: 99%

Dexamethasone and Long-Term Outcome of Tuberculous Meningitis in Vietnamese Adults and Adolescents

Török

Bang²,

Chau

et al. 2011

PLoS ONE

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BackgroundDexamethasone has been shown to reduce mortality in patients with tuberculous meningitis but the long-term outcome of the disease is unknown.MethodsVietnamese adults and adolescents with tuberculous meningitis recruited to a randomised, double-blind, placebo-controlled trial of adjunctive dexamethasone were followed-up at five years, to determine the effect of dexamethasone on long-term survival and neurological disability.Results545 patients were randomised to receive either dexamethasone (274 patients) or placebo (271 patients). 50 patients (9.2%) were lost to follow-up at five years. In all patients two-year survival, probabilities tended to be higher in the dexamethasone arm (0.63 versus 0.55; p = 0.07) but five-year survival rates were similar (0.54 versus 0.51, p = 0.51) in both groups. In patients with grade 1 TBM, but not with grade 2 or grade 3 TBM, the benefit of dexamethasone treatment tended to persist over time (five-year survival probabilities 0.69 versus 0.55, p = 0.07) but there was no conclusive evidence of treatment effect heterogeneity by TBM grade (p = 0.36). The dexamethasone group had a similar proportion of severely disabled patients among survivors at five years as the placebo group (17/128, 13.2% vs. 17/116, 14.7%) and there was no significant association between dexamethasone treatment and disability status at five years (p = 0.32).ConclusionsAdjunctive dexamethasone appears to improve the probability of survival in patients with TBM, until at least two years of follow-up. We could not demonstrate a five-year survival benefit of dexamethasone treatment which may be confined to patients with grade 1 TBM.Trial RegistrationClinicalTrials.gov NCT01317654 NCT01317654?term = tuberculous+meningitis&rank = 3

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“…Early studies suggested that corticosteroids reduced cerebrospinal fluid inflammation and time to recovery in patients with tuberculous meningitis, but the studies were too small to confirm any effect on survival. [3][4][5][6][7] Concern remained that corticosteroids might reduce the case fatality rate but increase the number of disabled patients. 8 Randomized trials performed in Egypt 9 and South Africa 10 provided evidence that corticosteroids improved survival in children with severe disease and probably reduced neurologic sequelae.…”

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confidence: 99%