Anti-TB treatment outcomes in TB meningitis: A systematic review and meta-analysis

Tuberculous meningitis (TBM) remains a leading cause of mortality and neurological disability in both children and adults. This systematic review and meta-analysis aim to assess the treatment outcomes of anti-tuberculosis drugs in TBM patients, focusing on mortality and neurological disability.

We conducted a comprehensive literature search on PubMed/MEDLINE, EMBASE, and Cochrane CENTRAL databases to identify articles reporting treatment outcomes in TBM up to December 15, 2024. Studies included in the analysis reported treatment outcomes for TBM patients. Pooled analyses were performed using random-effects model to assess mortality rates, neurological disability, and loss to follow-up.

A total of 10 studies involving 2005 patients were included in the analysis. The pooled all-cause mortality rate across studies was 27.7 % (95 % CI: 22.6-33.4 %, I ² : 76 %), with higher mortality observed in HIV-positive individuals (40.3 %) compared to HIV-negative patients (17.1 %). The pooled rate of loss to follow-up was 6.6 % (95 % CI: 4.7-9.1 %). Subgroup analysis revealed that the mortality rate increased from 18.9 % at 3 months to 29.1 % at 6 months. The frequency of neurological disability was higher among studies using the Modified Rankin Scale (41.7 %) compared to the Barthel Index (14.1 %).

This study highlights the high mortality and significant neurological disability in TBM patients, particularly in HIV-positive individuals. Our findings emphasize the need for standardized outcome reporting and the incorporation of new therapeutic strategies, and improved diagnostic tools, to enhance clinical outcomes. Future research should focus on addressing these areas to optimize treatment protocols and reduce the burden of TBM.