Steroidal Therapy plus Conventional Therapy versus Conventional Therapy alone for Tuberculous Meningitis: A systematic review and Meta-analysis

BackgroundTuberculosis meningitis (TBM) is the most severe form of extrapulmonary tuberculosis with a high rate of morbidity and mortality. Treatments for TBM include conventional therapy alone as well as adjunctive use of steroidal therapy. MethodsA comprehensive search of electronic databases such as PubMed, Cochrane, and Scopus was conducted from inception to April 2024 to retrieve all randomized controlled trials (RCTs) that compared steroidal therapy plus conventional antituberculosis therapy with antituberculosis therapy alone for patients of TBM. Meta-analysis was performed using Review Manager 5.4. Dichotomous outcomes were compared using risk ratio (RR). ResultsThere was a statistically significant decrease in risk of mortality in the Steroid group compared to the control group (RR 0.84; 95% CI 0.75, 0.94; p-value < 0.05). However, there was no statistically significant difference in the risk of neurological deficit between the two groups. There was a statistically significant reduction in the risk of adverse events in the steroidal therapy group compared to the control group (RR 0.90; 95% CI 0.83, 0.98; p-value = 0.03). Similarly, there was a significant improvement in the clinical efficacy in the steroidal therapy group compared to the control (RR 1.16; 95% CI 1.02, 1.31; p-value = 0.02). ConclusionSteroids in addition to antituberculosis therapy significantly reduce mortality and adverse events, while improving clinical outcomes in patients of TBM. There is a need for controlled studies with longer follow-up durations to improve the robustness of the results.