title: Corticosteroids (dexamethasone versus intravenous methylprednisolone) in patients with tuberculous meningitis.
abstract: As inflammatory changes play an important role in the neuropathogenesis of the disease, adjunctive corticosteroid treatment may be of benefit in tuberculous meningitis. In an open-label study in India, 97 patients with such meningitis were randomized into a control group, a dexamethasone group (with the drug given intravenously once a day for 4 weeks, and then orally, once daily, for another 4 weeks) and a methylprednisolone group (with the drug given intravenously once a day for 5 days). All the patients also received standard anti-tuberculosis drugs. The primary outcome measure was death or severe disability 6 months after the randomization, with a modified Rankin scale used to assess each patient's level of disability. The other outcome measures investigated were deterioration in vision, focal neurological deficits and new-onset seizures. Six patients (one of those given dexamethasone, three of those given methylprednisolone and two of those in the control group) were lost to follow-up. Although each corticosteroid was associated with a reduction in death or disability, this reduction did not reach statistical significance in either the dexamethasone group (relative risk of death=0.6, with a 95% confidence interval of 0.29-1.2; P>0.05) or the methylprednisolone group (relative risk of death=0.7, with a 95% confidence interval of 0.4-1.4; P>0.05), probably because of the small sample sizes. Among the patients who died within 10 months of randomization, the mean time to death (post-randomization) was 8.8 months in the dexamethasone group, 8.2 months in the methylprednisolone group, and 7.1 months in the control group (P>0.05). The prevalence of impaired vision, among all the patients evaluated, decreased from 41.8% at baseline to 29.9% (among the survivors) 6 months later. Adverse events were similar and equally reported in the two corticosteroid groups. Larger trials are still needed to determine if dexamethasone and/or methylprednisolone are useful in the treatment of tuberculous meningitis, at least in India.
authors.affiliation: Department of Neurology, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: H S
authors.initials: HS
authors.lastname: Malhotra
authors.forename: R K
authors.initials: RK
authors.lastname: Garg
authors.forename: M K
authors.initials: MK
authors.lastname: Singh
authors.forename: A
authors.initials: A
authors.lastname: Agarwal
authors.forename: R
authors.initials: R
authors.lastname: Verma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D016001:Confidence Intervals; D003907:Dexamethasone / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007275:Injections, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000401:mortality; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D003907:Dexamethasone; D008775:Methylprednisolone