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The Effect of Add-On Corticosteroids on Treatment Outcomes in Lymph Node Tuberculosis: A Systematic Review and
Chayanika Biswas1, A S Supriya1, Aravind Gandhi2
1Department of Community Medicine, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India.
Objective:
To assess the effect of add-on corticosteroids on treatment outcomes in lymph node tuberculosis.
Methods:
After registering the protocol on PROSPERO (CRD420251104064), we systematically searched Cochrane, MEDLINE, Embase and Web of Science for randomised controlled trials on adjunct corticosteroids for lymph node tuberculosis up to 20 October 2025. A random-effects model was applied, with heterogeneity quantified using I2 and between-study variance (τ 2) estimated by the Paule-Mandel method. Pooled effects were obtained using inverse-variance weighting, and confidence intervals were calculated with the Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment. Study quality was assessed using RoB 2, and the certainty of evidence was graded using the GRADE framework.
Results:
Of a total of 485 articles, removing duplicates and irrelevant articles yielded three articles that fulfilled PICOTS criteria. Adjunctive oral prednisone was used as the intervention in all three trials, and treatment outcomes were compared with standard antitubercular treatment. Pooled estimates indicated no significant benefit from the use of adjunctive corticosteroids for complete resolution at 6 months (RR = 1.61; 95% CI: 0.73, 3.56; very low-quality evidence) or symptomatic relief at 2 months (RR = 1.21; 95% CI: 0.92-1.58; low-quality evidence). Adjunctive corticosteroid therapy reduced complications by 77% during the course of treatment in the primary analysis (RR = 0.23; 95% CI: 0.18-0.29). The three studies were at high risk of bias. The certainty of evidence was rated as very low for the outcome of complete resolution at 6 months, low for symptomatic relief at 2 months, and moderate for complications.
Conclusion:
Though lymph node tuberculosis contributes to a significant portion of all tuberculosis cases, high-quality research related to the use of adjunctive corticosteroids is limited. There is a need for further studies to investigate this promising possibility.
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