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Abstract：
BACKGROUND: The treatment regimen for tuberculous meningitis (TBM) remains unclear and requires optimization. There are some reports on successful adjunct intrathecal dexamethasone and isoniazid (IDI) treatment strategies for TBM, however, there is equivocal evidence on their efficacy and safety.
METHODS: A comprehensive search of English and Chinese databases was conducted from inception to February 2024. A meta-analysis was performed on randomized controlled trials (RCTs) estimating the effects of adjunct IDI on conventional anti-TB (C anti-TB) treatments or C anti-TB alone. Efficacy, adverse reaction rate, cerebrospinal fluid (CSF) leukocytes, and CSF protein were used as primary outcome indicators. CSF glucose, CSF chlorides, CSF pressure, recovery time for laboratory indicators and recovery time for clinical symptoms were used as secondary outcome indicators.
RESULTS: A total of 17 studies involving 1360 (IDI group vs. C anti-TB group: 392 vs. 372; higher-dose IDI group vs. lower-dose IDI group: 319 vs. 277) patients were included in our analysis. Efficacy was significantly higher (RR 1.3, 95% CI 1.2-1.4, P < 0.001) and adverse reaction rate was significantly lower in the IDI groups (RR 0.59, 95% CI 0.37-0.92, P = 0.021). Furthermore, 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) were significantly lower in the IDI groups. Recovery time indicators were all shorter in the IDI groups, 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), respectively. 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).
CONCLUSIONS: Adjunct IDI with C anti-TB can enhance therapeutic outcomes and reduce adverse reaction rate in adult TBM patients, with higher-dose IDI showing superior efficacy. These findings highlight the potential of IDI as an adjunctive therapy in TBM management. However, more high-quality RCTs from more regions should be conducted to support our results.
BACKGROUND: Retrospectively registered in PROSPERO https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023388860 .
METHODS: A comprehensive search of English and Chinese databases was conducted from inception to February 2024. A meta-analysis was performed on randomized controlled trials (RCTs) estimating the effects of adjunct IDI on conventional anti-TB (C anti-TB) treatments or C anti-TB alone. Efficacy, adverse reaction rate, cerebrospinal fluid (CSF) leukocytes, and CSF protein were used as primary outcome indicators. CSF glucose, CSF chlorides, CSF pressure, recovery time for laboratory indicators and recovery time for clinical symptoms were used as secondary outcome indicators.
RESULTS: A total of 17 studies involving 1360 (IDI group vs. C anti-TB group: 392 vs. 372; higher-dose IDI group vs. lower-dose IDI group: 319 vs. 277) patients were included in our analysis. Efficacy was significantly higher (RR 1.3, 95% CI 1.2-1.4, P < 0.001) and adverse reaction rate was significantly lower in the IDI groups (RR 0.59, 95% CI 0.37-0.92, P = 0.021). Furthermore, 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) were significantly lower in the IDI groups. Recovery time indicators were all shorter in the IDI groups, 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), respectively. 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).
CONCLUSIONS: Adjunct IDI with C anti-TB can enhance therapeutic outcomes and reduce adverse reaction rate in adult TBM patients, with higher-dose IDI showing superior efficacy. These findings highlight the potential of IDI as an adjunctive therapy in TBM management. However, more high-quality RCTs from more regions should be conducted to support our results.
BACKGROUND: Retrospectively registered in PROSPERO https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023388860 .
摘要：
背景：结核性脑膜炎（TBM）的治疗方案尚不清楚，需要优化。有一些关于成功鞘内注射地塞米松和异烟肼（IDI）治疗TBM的报道，然而,它们的有效性和安全性有模棱两可的证据.
方法：从开始到2024年2月对中英文数据库进行了全面搜索。对随机对照试验（RCT）进行了荟萃分析，评估了辅助IDI对常规抗TB（C抗TB）治疗或单独的C抗TB的影响。功效,不良反应发生率,脑脊液（CSF）白细胞，和CSF蛋白作为主要结局指标。CSF葡萄糖，脑脊液氯化物，脑脊液压力,实验室指标恢复时间和临床症状恢复时间作为次要结局指标.
结果：共17项研究，涉及1360项（IDI组与C抗结核组：392vs.372；高剂量IDI组与低剂量IDI组：319vs.277)患者被纳入我们的分析。IDI组的疗效明显更高（RR1.3，95％CI1.2-1.4，P<0.001），不良反应发生率明显降低（RR0.59，95％CI0.37-0.92，P=0.021）。此外，脑脊液白细胞（WMD-29.33，95%CI[-40.64至-18.02]，P<0.001）和CSF蛋白（WMD-0.79，95CI[-0.96至-0.61]，P<0.001)在IDI组中显著降低。IDI组的恢复时间指标均较短，发烧（SMD-2.45，95%CI[-3.55至-1.35]，P<0.001)，昏迷（SMD-3.75，95%CI[-4.33至-3.17]，P<0.001)，和头痛（SMD-3.06，95%CI[-4.05至-2.07]，P<0.001)，分别。高剂量IDI比低剂量IDI更有效(RR1.23,95%CI1.14-1.33,P<0.001),两组不良反应发生率差异无统计学意义(RR0.82,95CI0.43~1.56,P=0.544)。
结论：在成人TBM患者中，IDI与C抗TB辅助治疗可提高治疗结果，降低不良反应发生率。较高剂量的IDI显示出较好的疗效。这些发现强调了IDI作为TBM管理辅助治疗的潜力。然而,应该从更多地区开展更多高质量的RCT来支持我们的结果.
背景：在PROSPEROhttps://www中回顾性注册。crd.约克。AC.uk/prospro/display_record.php?ID=CRD42023388860。
方法：从开始到2024年2月对中英文数据库进行了全面搜索。对随机对照试验（RCT）进行了荟萃分析，评估了辅助IDI对常规抗TB（C抗TB）治疗或单独的C抗TB的影响。功效,不良反应发生率,脑脊液（CSF）白细胞，和CSF蛋白作为主要结局指标。CSF葡萄糖，脑脊液氯化物，脑脊液压力,实验室指标恢复时间和临床症状恢复时间作为次要结局指标.
结果：共17项研究，涉及1360项（IDI组与C抗结核组：392vs.372；高剂量IDI组与低剂量IDI组：319vs.277)患者被纳入我们的分析。IDI组的疗效明显更高（RR1.3，95％CI1.2-1.4，P<0.001），不良反应发生率明显降低（RR0.59，95％CI0.37-0.92，P=0.021）。此外，脑脊液白细胞（WMD-29.33，95%CI[-40.64至-18.02]，P<0.001）和CSF蛋白（WMD-0.79，95CI[-0.96至-0.61]，P<0.001)在IDI组中显著降低。IDI组的恢复时间指标均较短，发烧（SMD-2.45，95%CI[-3.55至-1.35]，P<0.001)，昏迷（SMD-3.75，95%CI[-4.33至-3.17]，P<0.001)，和头痛（SMD-3.06，95%CI[-4.05至-2.07]，P<0.001)，分别。高剂量IDI比低剂量IDI更有效(RR1.23,95%CI1.14-1.33,P<0.001),两组不良反应发生率差异无统计学意义(RR0.82,95CI0.43~1.56,P=0.544)。
结论：在成人TBM患者中，IDI与C抗TB辅助治疗可提高治疗结果，降低不良反应发生率。较高剂量的IDI显示出较好的疗效。这些发现强调了IDI作为TBM管理辅助治疗的潜力。然而,应该从更多地区开展更多高质量的RCT来支持我们的结果.
背景：在PROSPEROhttps://www中回顾性注册。crd.约克。AC.uk/prospro/display_record.php?ID=CRD42023388860。
