Steroids for treating tuberculous pleurisy

TB of the pleura is associated with inflammation and fibrosis. Steroids could reduce the effects of the inflammation, but the immunosuppression could make patients vunerable.

This review aims to summarise the evidence about the effects of corticosteroids in patients with TB of the pleura, and explores if HIV status is associated with differences in effect estimates.

We searched the Cochrane Infectious Diseases Group trials register, the Cochrane Library, MEDLINE, and EMBASE. Lists of references from review articles and primary studies were scanned and experts in the field of tuberculosis were contacted.

Randomised and quasi-randomised trials evaluating the effects of adjunctive corticosteroids in patients diagnosed with TB pleurisy were sought. Both beneficial and adverse effects were noted.

Two authors independently applied inclusion criteria, assessed trial quality and extracted the relevant data.

Three small trials met the inclusion criteria( total participants n=236), conducted in only HIV negative patients, and with insufficient power to examine death as an outcome. There was no difference in residual lung function between steroid and control groups at completion of treatment. The point estimates for secondary outcomes tended towards benefit with steroids rather than harm, but none were significant; number with pleural fluid (RR 0.28, 95% CI 0.06 to 1.34), number with pleural thickening (RR 0.76, 95% 0.48 to 1.21), and number with pleural adhesions (RR 0.30, 95% CI 0.03 to 2.66). Adverse effects were few and did not result in treatment being discontinued.

There is insufficient evidence to know whether steroids are effective in tuberculous pleural effusion.