February 28, 2013
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Steroids may reduce TB mortality

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Recent data indicate that corticosteroids may help reduce mortality among those with all forms of tuberculosis.

“In clinical care, one enduring question is whether to use corticosteroids routinely in addition to antituberculosis drugs,” researchers from the United Kingdom wrote in The Lancet Infectious Disease. “The inflammatory response to infections damages tissues and treatment with steroids might counter this effect. However, steroids can make people vulnerable to other infections, could worsen the outcome of infection with mycobacterium tuberculosis and pharmacokinetic interactions between antituberculosis drugs and steroids have been documented.”

The researchers conducted a systematic review and meta-analysis to evaluate whether steroids were efficacious at preventing mortality in TB. They identified 41 trials that included people with TB in any organ system. There were no age, comorbidity or language restrictions, nor were there restrictions on the type, dose or duration of steroid treatment.

They found that steroids reduced mortality by 17% (RR=0.83; 95% CI, 0.74-0.92), an effect found in all organ groups. In a sensitivity analysis that excluded non-randomized trial, the results were similar. Among the 21 trials that included regimens with rifampin — a TB treatment that has had documented interactions with steroids — the results were similar (RR=0.85; 95% CI, 0.74-0.98).

“Our analysis suggests a benefit from steroids that seems to be consistent across organ systems,” the researchers wrote. “Even in the absence of contemporary data for rifampin-based regimens for treatment of pulmonary tuberculosis, if this result shows a true systemic effect across organ systems, it provides indirect evidence to suggest that steroids could be of benefit in pulmonary tuberculosis.

Disclosure: The researchers report no relevant financial disclosures.