Dataset Information

The efficacy and safety of adjunctive corticosteroids in the treatment of tuberculous pleurisy: a systematic review and meta-analysis.

ABSTRACT:

Purpose

To evaluate the efficacy and safety of adjunctive corticosteroids in the treatment of patients with tuberculous pleurisy.

Methods

The PubMed, Cochrane, Medline, Embase, Web of Science and Chinese National Knowledge Infrastructure were searched. Clinical trials of corticosteroids compared with control were eligible for inclusion.

Results

Ten studies (6 randomized controlled trials [RCTs] and 4 non-RCTs) with 957 participants met the inclusion criteria. Compared to the controls (placebos or non-steroids), adjunctive corticosteroid use reduced the risk of residual pleural fluid after 4 weeks and the number of days to symptom improvement; however, there was no convincing evidence to support the positive effects of corticosteroids over the long term (8 weeks) on residual pleural fluid, pleural thickening, or pleural adhesions, and there was no statistical difference between the corticosteroid group and control group with respect to 7-days relief of the clinical symptoms or death from any cause. In addition, more adverse events were observed in patients who received corticosteroids than in those in the control group.

Conclusions

Our results suggest that adjunctive corticosteroid use did not improve long-term efficacy and might induce more adverse events, although the risk of residual pleural fluid at 4 weeks and the number of days to symptom improvement were reduced.

SUBMITTER: Xie S

PROVIDER: S-EPMC5669971 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

The efficacy and safety of adjunctive corticosteroids in the treatment of tuberculous pleurisy: a systematic review and meta-analysis.

Xie Shuanshuan S Lu Lin L Li Ming M Xiong Mengting M Zhou Shunping S Zhang Guoliang G Peng Aimei A Wang Changhui C

Oncotarget 20170524 47

<h4>Purpose</h4>To evaluate the efficacy and safety of adjunctive corticosteroids in the treatment of patients with tuberculous pleurisy.<h4>Methods</h4>The PubMed, Cochrane, Medline, Embase, Web of Science and Chinese National Knowledge Infrastructure were searched. Clinical trials of corticosteroids compared with control were eligible for inclusion.<h4>Results</h4>Ten studies (6 randomized controlled trials [RCTs] and 4 non-RCTs) with 957 participants met the inclusion criteria. Compared to th ...[more]

PMID: 29137345

Similar Datasets

Project description: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.To evaluate the effects of adding corticosteroids to drug regimens for tuberculous pleural effusion.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.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.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.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).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.

Project description:BackgroundCorticosteroids or immunosuppressants and supportive treatment in reducing the risk of proteinuria and end-stage kidney disease (ESKD) in immunoglobulin A (IgA) nephropathy (IgAN) patients were still controversial. The purpose of this meta-analysis was to evaluate the efficacy and safety of immunosuppressants or corticosteroids compared with supportive therapy for treatment of IgAN in order to provide guidance for clinical practice.MethodsWe conducted an online search in PubMed, Embase, Cochrane Library, and Web of Science databases to collect randomized control trials (RCTs) about the efficacy and safety of immunosuppressants or corticosteroids compared with supportive therapy for treatment of IgA for relevant literature published from the databases' inception to August 21, 2021. The Cochrane risk assessment tool was used to assess the risk of bias in the included studies and analyzed by Revman 5.4 software, and Stata 15.0 statistical software was adopted for meta-analysis.ResultsA total of 10,622 related studies were retrieved, and 11 RCTs were finally included in the meta-analysis, with a total sample size of 809 cases. The primary outcome measures for immunosuppressants or corticosteroids were better than those for supportive therapy: proteinuria [weighted mean difference (WMD) =-0.54, 95% confidence interval (CI): -0.63, -0.44, Z =10.79, P<0.001] and ESKD [relative risk (RR) =0.189, 95% CI: 0.059, 0.605, Z =2.81, P=0.005]. The secondary outcome measures were also better than that for supportive treatment: glomerular filtration rate [standardized mean difference (SMD) =0.32, 95% CI: 0.09, 0.54, Z =2.48, P=0.013]. The incidence of adverse reactions was consistent with that of supportive treatment, and the difference was not statistically significant (RR =1.06, 95% CI: 0.71, 1.59, Z =0.28, P=0.777).DiscussionCurrent evidence shows that immunosuppressants and corticosteroids can significantly reduce the risk of proteinuria and ESKD in IgAN patients. Due to limited quality and quantity of the included studies, more high-quality studies are need to verify above conclusion. In addition, we hope that more rationally designed multicenter RCTs that are not limited to short-term treatment outcomes will be conducted in the future.

Project description:PurposeAcute respiratory distress syndrome (ARDS) is an acute and critical disease among children and adults, and previous studies have shown that the administration of corticosteroids remains controversial. Therefore, a meta-analysis of randomized controlled trials (RCTs) was performed to evaluate the safety and efficacy of corticosteroids.MethodsThe RCTs investigating the safety and efficacy of corticosteroids in ARDS were searched from electronic databases (Embase, Medline, and the Cochrane Central Register of Controlled Trials). The primary outcome was 28-day mortality. Heterogeneity was assessed using the Chi square test and I2 with the inspection level of 0.1 and 50%, respectively.ResultsFourteen RCTs (n = 1607) were included for analysis. Corticosteroids were found to reduce the risk of death in patients with ARDS (relative risk (RR) = 0.78, 95% confidence interval (CI): 0.70-0.87; P < 0.01). Moreover, no significant adverse events were observed, compared to placebo or standard support therapy. Further subgroup analysis showed that variables, such as adults (RR = 0.78; 95% CI: 0.70-0.88; P < 0.01), non-COVID-19 (RR = 0.71; 95% CI: 0.62-0.83; P < 0.01), methylprednisolone (RR = 0.70; 95% CI: 0.56-0.88; P < 0.01), and hydrocortisone (RR = 0.79; 95% CI: 0.63-0.98; P = 0.03) were associated with 28-day mortality among patients who used corticosteroids. However, no association was found, regarding children (RR = 0.21; 95% CI: 0.01-4.10; P = 0.30).ConclusionThe use of corticosteroids is an effective approach to reduce the risk of death in ARDS patients. However, this effect is associated with age, non-COVID-19 diseases, and methylprednisolone and hydrocortisone use. Therefore, evidence suggests patients with age ≥ 18 years and non-COVID-19 should be encouraged during the corticosteroid treatment. However, due to substantial differences in the use of corticosteroids among these studies, questions still remain regarding the dosage, optimal corticosteroid agent, and treatment duration in patients with ARDS.

Project description:BackgroundCorticosteroids are frequently used in practice to treat patients with neurological disorders. However, its effect for stroke and traumatic brain injury (TBI) remains controversial. This study aimed to systematically review and evaluate efficacy and safety of corticosteroids for the treatment of stroke and TBI.MethodsWe searched Ovid-Medline and Ovid-Embase databases for randomised controlled trials (RCTs) and cohort studies evaluating the efficacy and safety of corticosteroids in patients with ischaemic stroke, intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH) or TBI. The treatment intervention was corticosteroid, and the control was placebo or routine care. Outcome measures were death, functional outcomes and adverse events. We calculated odds ratio (OR) and 95% confidence interval (CI) for the effect size, pooled the results using random-effects modelling, and assessed heterogeneity by I2 statistic.ResultsWe identified 47 studies (41 RCTs and 6 cohort studies). Nine studies enrolled patients with ischaemic stroke (n = 2806), 6 studies for ICH (n = 1229), 1 study recruited both ischaemic stroke (n = 13) and ICH (n = 27), 10 studies for SAH (n = 1318) and 21 studies for TBI (n = 12,414). Dexamethasone was the most used corticosteroid (28 studies). Corticosteroids reduced risk of death at 3 months after ischaemic stroke (n = 1791; 31% vs. 26%, OR 0.77, 95% CI 0.62-0.95; df = 1, I2 = 0%) and after ICH (1 study; n = 850; 44% vs. 27%, OR 0.48, 95% CI 0.35-0.64), had no effect on death at 1 month after SAH (1 study; n = 140; 22% vs. 32%, OR 1.73, 95% CI 0.81-3.68), and increased risk of death at 6 months after TBI (n = 10,755; 23% vs. 27%, OR 1.20, 95% CI 1.10-1.32; df = 6, I2 = 0%). The pooled analyses found no significant effect of corticosteroids on functional outcome after ischaemic stroke, ICH, SAH or TBI, respectively.ConclusionCorticosteroids reduced the risk of death and in selected patients with stroke, such as those with large artery occlusion after thrombectomy, but increased the risk of death after TBI, had no effect on functional outcomes. Further trials are needed to identify individual stroke patients who may benefit from corticosteroids.Systematic review registrationInternational Prospective Register of Systematic Reviews (CRD42023474473).

Dataset Information

The efficacy and safety of adjunctive corticosteroids in the treatment of tuberculous pleurisy: a systematic review and meta-analysis.

Purpose

Methods

Results

Conclusions

Publications

The efficacy and safety of adjunctive corticosteroids in the treatment of tuberculous pleurisy: a systematic review and meta-analysis.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets