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Meta-Analysis
. 2023 Jul;270(7):3603-3615.
doi: 10.1007/s00415-023-11715-0. Epub 2023 Apr 15.

Steroids for the treatment of viral encephalitis: a systematic literature review and meta-analysis

Emira Hodzic  1 , Rodrigo Hasbun  2 , Alejandro Granillo  2 , Anna R Tröscher  3 , Helga Wagner  1 , Tim J von Oertzen  3   4 , Judith N Wagner  5   6
Affiliations
Meta-Analysis

Steroids for the treatment of viral encephalitis: a systematic literature review and meta-analysis

Emira Hodzic et al. J Neurol. 2023 Jul.

Abstract

Background: Specific antiviral treatment is only available for a small subset of viral encephalitis (VE). Adjunctive steroids are used, but there is scant evidence evaluating its utility. We present a systematic review and meta-analysis on the outcome of steroid use in VE.

Methods: We conducted a systematic literature review and reported it according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Two observational studies from unpublished or partially published data were added. For the meta-analysis, we employed the metaphor package of the statistical software R-4.3.1.

Results: We screened 378 studies and included 50. 155 patients were added from the Houston and Linz cohorts. Individual data were available for 281 persons, 120 (43%) of whom received steroids. The most common pathogens were herpes simplex virus 1, West Nile virus, and measles. Study designs and patient outcomes were heterogeneous. Only three of the trials report an advantage of steroid therapy. Steroid-induced side effects were scarce. Ten cohorts were included into the meta-analysis. For the pooled data, the null hypothesis could not be rejected (p = 0.245) using a random effects model, i.e., a benefit of steroid treatment on survival in VE could not be shown.

Conclusions: Steroids as potent anti-inflammatory agents may act through a reduction of secondary inflammation-mediated damage. Our data do not support the use of steroids in VE. However, multiple shortcomings apply. Standardized controlled trials are needed to investigate optimal dosing and timing of steroid administration and to explore potential subgroups that could benefit.

Keywords: Infectious diseases; Intensive care; Neurovirology; Steroids.

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Conflict of interest statement

None declared in relation to this study.

Figures

Fig. 1
Fig. 1
Selection of included reports. Flow chart depicting the selection process of reports included in this review according to PRISMA guideline
Fig. 2
Fig. 2
Pathogens in the patient cohort extracted from studies providing individual data
Fig. 3
Fig. 3
Forest Plot of the odds ratio (OR) for the risk of dying in patients who received steroids (C.P.) vs. those who did not (no C.P.)
See this image and copyright information in PMC

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References

    1. Venkatesan A, Tunkel AR, Bloch KC, et al. Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the international encephalitis consortium. Clin Infect Dis Off Publ Infect Dis Soc Am. 2013;57:1114–1128. doi: 10.1093/cid/cit458. - DOI - PMC - PubMed
    1. Tyler KL. Acute viral encephalitis. N Engl J Med. 2018;379:557–566. doi: 10.1056/NEJMra1708714. - DOI - PubMed
    1. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097. doi: 10.1371/journal.pmed.1000097. - DOI - PMC - PubMed
    1. Allana A, Samannodi M, Hansen MA, et al. Adjunctive steroids in adults with encephalitis: a propensity score analysis. J Neurol. 2021;268:2151–2160. doi: 10.1007/s00415-021-10398-9. - DOI - PubMed
    1. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–926. doi: 10.1136/bmj.39489.470347.AD. - DOI - PMC - PubMed

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