Intrathecal therapy for tuberculous meningitis: propensity-matched cohort study

Area of Science:

• Neurology
• Infectious Diseases
• Pharmacology

Background:

• Tuberculous meningitis (TBM) is a severe form of tuberculosis affecting the central nervous system.
• Standard treatment involves systemic anti-TB therapy, but outcomes can be poor.
• Novel therapeutic strategies are needed to improve patient prognosis.

Purpose of the Study:

• To evaluate the safety and efficacy of intrathecal (IT) isoniazid (INH) and prednisolone combined with systemic anti-TB therapy for TBM.
• To compare this combined approach against systemic anti-TB therapy alone in adult patients.

Main Methods:

• A retrospective study analyzed 198 adult TBM patients.
• Patients were divided into two groups: systemic therapy alone (Group A) and systemic therapy plus IT INH and prednisolone (Group B).
• Propensity score matching (PSM) was used to create comparable cohorts for outcome analysis.

Main Results:

• After PSM, 30 patients were analyzed in each group.
• Mortality was significantly lower in the group receiving additional IT therapy (13.3%) compared to the systemic therapy alone group (36.7%, P=0.037).

Conclusions:

• The addition of IT INH and prednisolone to systemic anti-TB therapy appears effective in improving outcomes for adult TBM patients.
• Further large-scale, prospective, randomized controlled trials are recommended to confirm findings and determine optimal IT therapy timing and indications.