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

Abstract

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.