title: Dexamethasone and long-term outcome of tuberculous meningitis in Vietnamese adults and adolescents.
abstract: BACKGROUND
  Dexamethasone has been shown to reduce mortality in patients with tuberculous meningitis but the long-term outcome of the disease is unknown.
  
  
  METHODS
  Vietnamese adults and adolescents with tuberculous meningitis recruited to a randomised, double-blind, placebo-controlled trial of adjunctive dexamethasone were followed-up at five years, to determine the effect of dexamethasone on long-term survival and neurological disability.
  
  
  RESULTS
  545 patients were randomised to receive either dexamethasone (274 patients) or placebo (271 patients). 50 patients (9.2%) were lost to follow-up at five years. In all patients two-year survival, probabilities tended to be higher in the dexamethasone arm (0.63 versus 0.55; p = 0.07) but five-year survival rates were similar (0.54 versus 0.51, p = 0.51) in both groups. In patients with grade 1 TBM, but not with grade 2 or grade 3 TBM, the benefit of dexamethasone treatment tended to persist over time (five-year survival probabilities 0.69 versus 0.55, p = 0.07) but there was no conclusive evidence of treatment effect heterogeneity by TBM grade (p = 0.36). The dexamethasone group had a similar proportion of severely disabled patients among survivors at five years as the placebo group (17/128, 13.2% vs. 17/116, 14.7%) and there was no significant association between dexamethasone treatment and disability status at five years (p = 0.32).
  
  
  CONCLUSIONS
  Adjunctive dexamethasone appears to improve the probability of survival in patients with TBM, until at least two years of follow-up. We could not demonstrate a five-year survival benefit of dexamethasone treatment which may be confined to patients with grade 1 TBM.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01317654.
authors.affiliation: Department of Medicine, University of Cambridge, Cambridge, United Kingdom. estee.torok@addenbrookes.nhs.uk
authors.forename: M Estée
authors.initials: ME
authors.lastname: Török
authors.forename: Duc Bang
authors.initials: DB
authors.lastname: Nguyen
authors.forename: Thi Hong Chau
authors.initials: TH
authors.lastname: Tran
authors.forename: Thi Bich Yen
authors.initials: TB
authors.lastname: Nguyen
authors.forename: Guy E
authors.initials: GE
authors.lastname: Thwaites
authors.forename: Thi Quy
authors.initials: TQ
authors.lastname: Hoang
authors.forename: Huy Dung
authors.initials: HD
authors.lastname: Nguyen
authors.forename: Tinh Hien
authors.initials: TH
authors.lastname: Tran
authors.forename: Tran Chinh
authors.initials: TC
authors.lastname: Nguyen
authors.forename: Hoang Thi Thanh
authors.initials: HT
authors.lastname: Hoang
authors.forename: Marcel
authors.initials: M
authors.lastname: Wolbers
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Farrar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D013997:Time Factors; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000188:drug therapy*; D014744:Vietnam; D055815:Young Adult
chemical_list: D003907:Dexamethasone