The following is a summary of “Efficacy and safety of intrathecal dexamethasone combined with isoniazid in the treatment of tuberculous meningitis: a meta-analysis,” published in the June 2024 issue of Neurology by Gao et al.
Researchers conducted a retrospective study investigating the past use of adjunct intrathecal dexamethasone and isoniazid (IDI) in treating tuberculous meningitis (TBM).
They extensively searched English and Chinese databases from the beginning to February 2024. A meta-analysis was conducted on RCTs, assessing the impact of adjunct IDI on C anti-TB treatments or C anti-TB alone. Primary outcomes included efficacy, adverse reaction rate, CSF leukocytes, and CSF protein. Secondary outcomes encompass CSF glucose, CSF chlorides, CSF pressure, laboratory indicators recovery time, and clinical symptom recovery time.
The results showed 17 studies involving 1,360 patients (IDI group vs. C anti-TB group: 392 vs. 372; higher-dose IDI group vs. lower-dose IDI group: 319 vs. 277). Efficacy significantly increased (RR 1.3, 95% CI 1.2-1.4, P<0.001), and adverse reaction rate significantly decreased in the IDI groups (RR 0.59, 95% CI 0.37-0.92, P=0.021). Additionally, CSF leukocytes (WMD - 29.33, 95% CI [- 40.64 to-18.02], P<0.001) and CSF protein (WMD – 0.79, 95%CI [-0.96 to-0.61], P<0.001) decreased significantly in the IDI groups. Recovery time indicators were shorter in the IDI groups for fever (SMD – 2.45, 95% CI [-3.55 to-1.35], P<0.001), coma (SMD-3.75, 95% CI [-4.33 to-3.17], P<0.001), and headache (SMD -3.06, 95% CI [- 4.05 to-2.07], P<0.001). Higher-dose IDI was more effective than lower-dose IDI (RR 1.23, 95% CI 1.14-1.33, P<0.001), with no significant difference in adverse reaction rate between the two (RR 0.82, 95%CI 0.43–1.56, P=0.544).
Investigators concluded that more research was needed to confirm the effectiveness of adjunct IDI for TBM.
Source: bmcneurol.biomedcentral.com/articles/10.1186/s12883-024-03701-4
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