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Meta-Analysis
. 2017 Mar 14;3(3):CD001876.
doi: 10.1002/14651858.CD001876.pub3.

Corticosteroids for tuberculous pleurisy

Hannah Ryan  1 , Jinho Yoo  2 , Padmapriya Darsini  3
Affiliations
Meta-Analysis

Corticosteroids for tuberculous pleurisy

Hannah Ryan et al. Cochrane Database Syst Rev. .

Abstract

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 reported that average percentage predicted forced vital capacity was similar in the group receiving prednisolone and in the control group (very low certainty evidence).The risk of adverse events that led to discontinuation of the trial drug was higher in people with pleural TB receiving corticosteroids (RR 2.78, 95% CI 1.11 to 6.94; 587 participants, 6 trials, low certainty evidence). The trial in HIV-positive people reported on six different HIV-related infections, with no obvious differences. However, cases of Kaposi's sarcoma were only seen in the corticosteroid group (with 6/99 cases in the steroid group compared to 0/98 in the control group) (very low certainty evidence).

Authors' conclusions: Long-term respiratory function is potentially the most important outcome for assessing the effects of adjunctive treatments for people with pleural TB. However, the information on the impact of pleural TB on long-term respiratory function is unknown and could be eclipsed by other risk factors, such as concurrent pulmonary TB, smoking, and HIV. This probably needs to be quantified to help decide whether further trials of corticosteroids for pleural TB would be worthwhile.

PubMed Disclaimer

Conflict of interest statement

HR was employed by the Cochrane Infectious Diseases Group, which is funded by a grant from the UK Government DFID.

PD is employed by the National Institute for Research in Tuberculosis, Chennai, a permanent institute under the Indian Council of Medical Research, which is funded by the Government of India through the Ministry of Health and Family Welfare.

HR and PD conducted the preliminary work that contributed to the conception and design of this Cochrane Review as part of the evidence review process for the Indian Extra‐Pulmonary TB (INDEX‐TB) Guidelines, a guideline for extrapulmonary TB commissioned by the Ministry of Health and Family Welfare, Government of India. Global Health Advocates funded this guideline, and the All India Institute of Medical Sciences, New Delhi convened it.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each 'Risk of bias' item presented as percentages across all included trials.
3
3
'Risk of bias' summary: review authors' judgements about each 'Risk of bias' item for each included trial.
1.1
1.1. Analysis
Comparison 1 Corticosteroids versus control (placebo or no steroids), Outcome 1 Residual pleural effusion on chest X‐ray.
1.2
1.2. Analysis
Comparison 1 Corticosteroids versus control (placebo or no steroids), Outcome 2 Pleural changes at the end of treatment (pleural thickening and pleural adhesions).
1.3
1.3. Analysis
Comparison 1 Corticosteroids versus control (placebo or no steroids), Outcome 3 Death from any cause.
1.4
1.4. Analysis
Comparison 1 Corticosteroids versus control (placebo or no steroids), Outcome 4 Adverse events leading to study drug discontinuation.
1.5
1.5. Analysis
Comparison 1 Corticosteroids versus control (placebo or no steroids), Outcome 5 HIV‐associated adverse events.
2.1
2.1. Analysis
Comparison 2 Effect of study quality on the outcome residual pleural fluid on chest X‐ray, Outcome 1 Residual pleural fluid on chest X‐ray ‐ studies at high risk of selection bias excluded.
2.2
2.2. Analysis
Comparison 2 Effect of study quality on the outcome residual pleural fluid on chest X‐ray, Outcome 2 Residual pleural fluid on chest X‐ray ‐ studies at high risk of selection bias included.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Bang 1997 {published data only}
    1. Bang JS, Kim MS, Kwak SM, Cho CH. Evaluation of steroid therapy in tuberculous pleurisy ‐ a prospective, randomized study. Tuberculosis and Respiratory Disease 1997;44(1):52‐8.
Elliott 2004 {published and unpublished data}
    1. Elliott AM, Luzze H, Quigley MA, Nakiyingi J, Kyaligonza S, Namujju PB, et al. A randomized, double‐blind, placebo‐controlled trial of the use of prednisolone as an adjunct to treatment in HIV‐1‐associated pleural tuberculosis. Journal of Infectious Diseases 2004;190(5):869‐78. - PubMed
Galarza 1995 {published data only}
    1. Galarza I, Cañete C, Granados A, Estopà R, Manresa F. Randomised trial of corticosteroids in the treatment of tuberculous pleurisy. Thorax 1995;50(12):1305‐7. - PMC - PubMed
Lee 1988 {published data only}
    1. Lee CH, Wang WJ, Lan RS, Tsai YH, Chiang YC. Corticosteroids in the treatment of tuberculous pleurisy. A double‐blind, placebo‐controlled, randomized study. Chest 1988;94(6):1256‐9. - PubMed
Lee 1999 {published data only}
    1. Lee BH, Jee HS, Choi JC, Park YB, An CH, Kim JY, et al. Therapeutic effect of prednisolone in tuberculous pleurisy ‐ a prospective study for the prevention of the pleural adhesion. Tuberculosis and Respiratory Disease 1999;46(4):481‐8.
Wyser 1996 {published data only}
    1. Wyser C, Walzl G, Smedema JP, Swart F, Schalkwyk EM, Wal BW. Corticosteroids in the treatment of tuberculous pleurisy. A double‐blind, placebo‐controlled, randomized study. Chest 1996;110(2):333‐8. - PubMed

References to studies excluded from this review

Aspin 1958 {published data only}
    1. Aspin J, O'Hara H. Steroid‐treated tuberculous pleural effusions. British Journal of Tuberculosis and Diseases of the Chest 1958;52(1):81‐3. - PubMed
Bilaceroglu 1999 {published data only}
    1. Bilaceroglu S, Perim K, Büyükşirin M, Celikten E. Prednisolone: a beneficial and safe adjunct to antituberculosis treatment? A randomized controlled trial. International Journal of Tuberculosis and Lung Disease 1999;3(1):47‐54. - PubMed
Cherednikova 1973 {published data only}
    1. Cherednikova GV. Immediate and late results of treatment with corticosteroid hormones of children with tuberculosis [Blizhaishie i otdalennye rezul'taty lecheniia kortikosteroidnymi gormonami detei, bol'nykh tuberkulezom]. Problemy Tuberkuleza 1973;51(12):46‐9. - PubMed
Cisneros 1996 {published data only}
    1. Cisneros JR, Murray KM. Corticosteroids in tuberculosis. Annals of Pharmacotherapy 1996;30(11):1298‐303. - PubMed
Damany 1968 {published data only}
    1. Damany SJ, Shah KT. Treatment of pleural effusion with and without triamcinolone in addition to usual antituberculosis chemotherapy. Journal of the Indian Medical Association 1968;51(8):391‐3. - PubMed
Filler 1963 {published data only}
    1. Filler J, Porter M. Physiologic studies of the sequelae of tuberculous pleural effusion in children treated with antimicrobial drugs and prednisone. American Review of Respiratory Disease 1963;88:181‐8. - PubMed
Fleishman 1960 {published data only}
    1. Fleishman SI, Coetzee AM, Mindel S, Berjak J, Lichter AI. Antituberculous therapy combined with adrenal steroids in the treatment of pleural effusions: a controlled therapeutic trial. Lancet 1960;1(7117):199‐201. - PubMed
Grewal 1969 {published data only}
    1. Grewal KS, Dixit RP, Sil DR. A comparative study of therapeutic regimens with and without corticosteroids in the treatment of tuberculous pleural effusion. Journal of the Indian Medical Association 1969;52(11):514‐6. - PubMed
Khomenko 1990 {published data only}
    1. Khomenko IS, Chukanov VI, Gergert VI, Utkin VV. Effectiveness of antitubercular chemotherapy combined with corticosteroids and immunomodulators [Effektivnost' protivotuberkuleznoi khimioterapii v sochetanii s kortikosteroidami i immunomoduliatorami]. Problemy Tuberkuleza 1990;1:24‐8. - PubMed
Manresa 1997 {published data only}
    1. Manresa F, Galarza I, Cañete C. Using corticosteroids to treat tuberculous pleurisy. Chest 1997;112(1):291‐2. - PubMed
Mansour 2006 {published data only}
    1. Mansour AA, Al‐Rbeay TB. Adjunct therapy with corticosteroids or paracentesis for treatment of tuberculous pleural effusion. Eastern Mediterreanean Health Journal 2006;12(5):504‐8. - PubMed
Mathur 1960 {published data only}
    1. Mathur KS, Prasad R, Mathur JS. Intrapleural hydrocortisone in tuberculous pleural effusion. Tubercle 1960;41:358‐62. - PubMed
Mathur 1965 {published data only}
    1. Mathur KS, Mathur JS, Sapru RP. Treatment of tuberculosis pleural effusion with local instillation of hydrocortisone. Diseases of the Chest 1965;47:83‐7. - PubMed
Mayanja‐Kizza 2005 {published data only}
    1. Mayanja‐Kizza H, Jones‐Lopez E, Okwera A, Wallis R, Ellner J, Mugerwa R, et al. Immunoadjuvant prednisolone therapy for HIV‐associated tuberculosis: a phase 2 clinical trial in Uganda. Journal of Infectious Diseases 2005;191(6):856‐65. - PMC - PubMed
Menon 1964 {published data only}
    1. Menon NK. Steroid therapy in tuberculous pleural effusion. Tubercle 1964;45:17‐20. - PubMed
Paheco 1973 {published data only}
    1. Pacheco CR, Valdez‐Ochoa S, Naranjo F, Alvarez H, Aguilar M, Saavedra M. Clinical study of a new synthetic steroid in the treatment of pleural tuberculosis [Estudio clinico de un nuevo esteroide de sintesis en el tratamiento de la pleuresia tuberculosa]. Gaceta Medica de Mexico 1973;106(3):249‐55. - PubMed
Paley 1959 {published data only}
    1. Paley SS, Mihaly JP, Mais EL, Gittens SA, Lupini B. Prednisolone in the treatment of tuberculous pleural effusions. American Review of Tuberculosis 1959;79:307‐14. - PubMed
Porsio 1966 {published data only}
    1. Porsio A, Borgia M. Controlled clinical trials of the use of a new anabolic agent in a Sanatorium. La Clinica Terapeutica 1966;37(6):502‐18. - PubMed
Singh 1965 {published data only}
    1. Singh D, Yesikar SS. Role of intrapleural corticosteroids in tuberculous pleural effusion: a clinicotherapeutic trial of 50 cases. Journal of the Indian Medical Association 1965;45(6):306‐9. - PubMed
Starostenko 1989 {published data only}
    1. Starostenko EV, Novoselova VP. Indications for the use of prednisolone in tuberculosis. Problemy Tuberkuleza 1989;1:44‐7. - PubMed
Tani 1964 {published data only}
    1. Tani P, Poppius H, Maekipaja J. Cortisone therapy for exudative tuberculous pleurisy in the light of a follow‐up study. Acta Tuberculosea et Pneumologica Scandinavica 1964;44:303‐9. - PubMed
Tanzj 1965 {published data only}
    1. Tanzj PL, Andreini E. On therapeutic use of corticosteroids in pleuro‐pulmonary tuberculosis. Archivio di Tisiologia e delle Malattie dell'Apparato Respiratorio 1965;20(5):331‐57. - PubMed

References to ongoing studies

ChiCTR‐TRC‐10000747 {published data only}
    1. ChiCTR‐TRC‐10000747. A multi‐center, randomized, double‐blind, parallel placebo trial to evaluate the clinical efficacy of glucocorticosteroid for tuberculous pleurisy. www.chictr.org/en/proj/show.aspx?proj=654 (first received 1 January 2010). [ChiCTR‐TRC‐10000747]
NCT00338793 {published data only}
    1. NCT00338793. A Multicenter, Placebo‐Controlled, Double‐Blind, Randomized Clinical Trial to Evaluate the Efficacy and Safety of Corticosteroids for Treatment of Patients With Tuberculous Pleurisy. clinicaltrials.gov/show/NCT00338793 (first received 19 June 2006). [NCT00338793]

Additional references

Anonymous 1983
    1. Anonymous. Study of chemotherapy regimens of 5 and 7 months' duration and the role of corticosteroids in the treatment of sputum‐positive patients with pulmonary tuberculosis in South India. Tubercle 1983;64(2):73‐91. - PubMed
Barnes 2006
    1. Barnes PJ. How corticosteroids control inflammation: Quintiles Prize Lecture 2005. British Journal of Pharmacology 2006;148(3):245‐54. - PMC - PubMed
Batungwanayo 1993
    1. Batungwanayo J, Taelman H, Allen S, Bogaerts J, Kagame A, Perre P. Pleural effusion, tuberculosis and HIV‐1 infection in Kigali, Rwanda. AIDS 1993;7(1):73‐9. - PubMed
Blumberg 2003
    1. Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN, et al. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. American Journal of Respiratory and Critical Care Medicine 2003;167(4):603‐62. - PubMed
BNF 2016
    1. Joint Formulary Committee. British National Formulary. 72. London: BMJ Group and Pharmaceutical Press, 2016.
Byrne 2015
    1. Byrne AL, Marais BJ, Mitnick CD, Lecca L, Marks GB. Tuberculosis and chronic respiratory disease: a systematic review. International Journal of Infectious Diseases 2015;32:138‐46. - PubMed
Candela 2003
    1. Candela A, Andujar J, Hernández L, Martín C, Barroso E, Arriero JM, et al. Functional sequelae of tuberculous pleurisy in patients correctly treated. Chest 2003;123(6):1996‐2000. - PubMed
Cañete 1994
    1. Cañete C, Galarza I, Granados A, Farrero E, Estopà R, Manresa F. Tuberculous pleural effusion: experience with six months of treatment with isoniazid and rifampicin. Thorax 1994;49(11):1160‐1. - PMC - PubMed
Chapman 2004
    1. Chapman SJ, Davies RJ. The management of pleural space infections. Respirology 2004;9(1):4‐11. - PubMed
Critchley 2014
    1. Critchley JA, Orton LC, Pearson F. Adjunctive steroid therapy for managing pulmonary tuberculosis. Cochrane Database of Systematic Reviews 2014, Issue 11. [DOI: 10.1002/14651858.CD011370] - DOI - PMC - PubMed
Denkinger 2014
    1. Denkinger CM, Schumacher SG, Boehme CC, Dendukuri N, Pai M, Steingart KR. Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: asystematic review and meta‐analysis. European Respiratory Journal 2014;44(2):435‐46. - PubMed
Dooley 1997
    1. Dooley DP, Carpenter JL, Rademacher S. Adjunctive corticosteroid therapy for tuberculosis: a critical reappraisal of the literature. Clinical Infectious Diseases 1997;25(4):872‐87. - PubMed
Elliott 1992
    1. Elliott AM, Halwiindi B, Bagshawe A, Hayes RJ, Luo N, Pobee JO, et al. Use of prednisolone in the treatment of HIV‐positive tuberculosis patients. Quarterly Journal of Medicine 1992;85(307‐8):855‐60. - PubMed
Ensoli 2001
    1. Ensoli B, Sgadari C, Barillari G, Sirianni MC, Stürzl M, Monini P. Biology of Kaposi's sarcoma. European Journal of Cancer 2001;37(10):1251‐69. - PubMed
Ferreiro 2014
    1. Ferreiro L, San José E, Valdés L. Tuberculous Pleural Effusion. Archivos de Bronconeumologia 2014;50(10):435‐43. - PubMed
Frye 1997
    1. Frye MD, Pozsik CJ, Sahn SA. Tuberculous pleurisy is more common in AIDS than in non‐AIDS patients with tuberculosis. Chest 1997;112(2):393‐7. - PubMed
GRADEpro GDT 2014 [Computer program]
    1. GRADE Working Group, McMaster University. GRADEpro Guideline Development Tool (GDT). Version accessed 20 November 2016. Hamilton (ON): GRADE Working Group, McMaster University, 2014.
Higgins 2011
    1. Higgins JPT, Altman DG, Sterne JAC. Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions (updated March 2011). The Cochrane Collaboration, 2011.
INDEX‐TB 2016
    1. INDEX‐TB Guidelines Group. INDEX‐TB Guidelines ‐ Guidelines on Extrapulmonary Tuberculosis for India. New Delhi: Ministry of Health and Family Welfare, Government of India, 2016.
Jeon 2014
    1. Jeon D. Tuberculous pleurisy: an update. Tuberculosis and Respiratory Diseases 2014;76(4):153‐9. - PMC - PubMed
Jüni 2001
    1. Jüni P, Altman DG, Egger M. Systematic reviews in health care: assessing the quality of controlled clinical trials. BMJ 2001;323(7303):42‐6. - PMC - PubMed
Kadhiravan 2010
    1. Kadhiravan T, Deepanjali S. Role of corticosteroids in the treatment of tuberculosis: an evidence‐based update. Indian Journal of Chest Diseases and Allied Sciences 2010;52(3):153‐8. - PubMed
Kim 2006
    1. Kim HJ, Lee HJ, Kwon SY, Yoon HI, Chung HS, Lee CT, et al. The prevalence of pulmonary parenchymal tuberculosis in patients with tuberculous pleuritis. Chest 2006;129(5):1253‐8. - PubMed
Lefebvre 2011
    1. Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JPT, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Lemaistre 1951
    1. Lemaistre CA, Tompsett R, Muschenheim C, Moore JA, McDermott W. Effects of adrenocorticotropic hormone and cortisone in patients with tuberculosis. Journal of Clinical Investigation 1951;30(5):445‐56. - PMC - PubMed
Light 2010
    1. Light RW. Update on tuberculous pleural effusion. Respirology 2010;15(3):451–8. - PubMed
Morehead 1998
    1. Morehead RS. Tuberculosis of the pleura. Southern Medical Journal 1998;91(7):630‐6. - PubMed
NICE 2016
    1. National Institute for Health and Care Excellence. NICE Guideline NG33: Tuberculosis. National Institute for Health and Care Excellence, May 2016.
Pozniak 1995
    1. Pozniak AL, MacLeod GA, Ndlovu D, Ross E, Mahari M, Weinberg J. Clinical and chest radiographic features of tuberculosis associated with human immunodeficiency virus in Zimbabwe. American Journal of Respiratory and Critical Care Medicine 1995;152(5 Pt 1):1558–61. - PubMed
Review Manager 5 [Computer program]
    1. Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Rossi 1987
    1. Rossi GA, Balbi B, Manca F. Tuberculous pleural effusions. Evidence for selective presence of PPD‐specific T‐lymphocytes at site of inflammation in the early phase of the infection. American Review of Respiratory Disease 1987;136(3):575‐9. - PubMed
Saks 1992
    1. Saks AM, Posner R. Tuberculosis in HIV positive patients in SouthAfrica: a comparative radiological study with HIV negative patients. Clinical Radiology 1992;46(6):387‐90. - PubMed
Semeere 2016
    1. Semeere A, Wenger M, Busakhala N, Buziba N, Bwana M, Muyindike W, et al. A prospective ascertainment of cancer incidence in sub‐Saharan Africa: the case of Kaposi sarcoma. Cancer Medicine 2016;5(5):914‐28. - PMC - PubMed
Sharma 2004
    1. Sharma SK, Mohan A. Extrapulmonary tuberculosis. Indian Journal of Medical Research 2004;120(4):316‐53. - PubMed
Shu 2011
    1. Shu C‐C, Wang J‐T, Wang J‐Y, Lee L‐N, Yu C‐J. In‐hospital outcome of patients with culture‐confirmed tuberculous pleurisy: clinical impact of pulmonary involvement. BMC Infectious Diseases 2011;11:46. - PMC - PubMed
Stead 1955
    1. Stead WW, Eichenholz A, Stauss H‐K. Operative and pathologic findings in twenty‐four patients with syndrome of idiopathic pleurisy with effusion, presumably tuberculous. American Review of Tuberculosis 1955;71(4):473–502. - PubMed
Valdés 1998
    1. Valdés L, Alvarez D, San José E, Penela P, Valle JM, García‐Pazos JM, et al. Tuberculous pleurisy: a study of 254 patients. Archives of Internal Medicine 1998;158(18):2017‐21. - PubMed
van Zyl Smit 2010
    1. Zyl Smit RN, Pai M, Yew WW, Leung CC, Zumla A, Bateman ED, et al. Global lung health: the colliding epidemics of tuberculosis, tobacco smoking, HIV and COPD. European Respiratory Journal 2010;35(1):27‐33. - PMC - PubMed
WHO 2010
    1. World Health Organization. Treatment of Tuberculosis Guidelines. 4th Edition. Geneva: World Health Organization, 2010.
WHO 2015
    1. World Health Organization. Global Tuberculosis Report 2015. Global Tuberculosis Report 2015. Geneva: World Health Organization, 2015.

References to other published versions of this review

Engel 2007
    1. Engel ME, Matchaba PT, Volmink J. Corticosteroids for tuberculous pleurisy. Cochrane Database of Systematic Reviews 2007, Issue 4. [DOI: 10.1002/14651858.CD001876.pub2] - DOI - PubMed
Matchaba 2000
    1. Matchaba PT, Volmink J. Steroids for treating tuberculous pleurisy. Cochrane Database of Systematic Reviews 2000, Issue 1. [DOI: 10.1002/14651858.CD001876] - DOI - PubMed

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