Corticosteroids for tuberculous pleurisy

UPDATED

Hannah Ryan1, Jinho Yoo2, Padmapriya Darsini3

1. Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK
2. Kyung Hee University, Seoul, South Korea
3. The National Institute for Reseach in Tuberculosis, Chennai, India

Ryan H, Yoo J, Darsini P. Corticosteroids for tuberculous pleurisy. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD001876. DOI: 10.1002/14651858.CD001876.pub3

Access the full-text article here: 10.1002/14651858.CD001876.pub3

What is tuberculous pleurisy and how might corticosteroids work?

Tuberculous pleurisy results from inflammation of the membrane that covers the lungs (the pleura) caused by exposure to Mycobacterium tuberculosis bacteria infecting the lungs. This results in a build up of fluid around the lung (pleural effusion) that causes pain and fever, impairs breathing, and may lead to impairment of lung function in the long term.

Some clinicians believe that corticosteroids used in combination with antituberculous drugs can speed up the recovery from TB pleurisy and help to prevent long-term complications.

What the evidence shows

We examined the available evidence up to 13 April 2016 and included six trials with 590 people, which evaluated prednisolone given with antituberculous treatment (ATT). One included trial was of high quality, while the rest had uncertainties regarding trial quality. All the included trials were in adults; one trial included only HIV-positive people, two included only HIV-negative people, and three did not report the HIV status of the participants.

Corticosteroids may reduce the time to resolution of the symptoms of TB pleurisy and the time to resolution of the pleural effusion on chest X-ray (low certainty evidence). Corticosteroids may also reduce the risk of having signs of pleural scarring on chest X-ray (pleural thickening and pleural adhesions) after the disease has resolved (low certainty evidence). There was not enough information about lung function to be sure whether or not corticosteroids reduce the risk of lung function impairment after TB pleurisy (very low certainty evidence).

Corticosteroids may increase the risk of adverse events leading to discontinuation of the trial drug (low certainty evidence). From one trial in people living with HIV, there was no detectable increase in HIV-related conditions with corticosteroids, although cases of Kaposi's sarcoma were only seen in the corticosteroid group and numbers of participants and events were too small to rule out an effect of corticosteroids (very low certainty evidence).

As the risk of disability and long-term illness after TB pleurisy is unclear, research looking at the association between TB pleurisy and lung function impairment would be useful to inform future research into corticosteroids for TB pleurisy.