The efficacy and safety of adjunctive corticosteroids in the treatment of tuberculous pleurisy: a systematic review and meta-analysis
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Shuanshuan Xie1,*, Lin Lu2,*, Ming Li1, Mengting Xiong3, Shunping Zhou4, Guoliang Zhang1, Aimei Peng1 and Changhui Wang1
1 Department of Respiratory Medicine, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
2 Department of Nephrology, North Huashan Hospital, Fudan University, Shanghai, China
3 Department of Cardiology Medicine, Pudong Hospital, Fudan University, Shanghai, China
4 Department of Cardiology Medicine, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
* These authors contributed equally to this study
Changhui Wang, email:
Aimei Peng, email:
Keywords: tuberculous pleurisy, corticosteroid, pleural fluid, pleural thickening, pleural adhesion
Received: August 15, 2016 Accepted: March 09, 2017 Published: May 24, 2017
Purpose: To evaluate the efficacy and safety of adjunctive corticosteroids in the treatment of patients with tuberculous pleurisy.
Methods: The PubMed, Cochrane, Medline, Embase, Web of Science and Chinese National Knowledge Infrastructure were searched. Clinical trials of corticosteroids compared with control were eligible for inclusion.
Results: Ten studies (6 randomized controlled trials [RCTs] and 4 non-RCTs) with 957 participants met the inclusion criteria. Compared to the controls (placebos or non-steroids), adjunctive corticosteroid use reduced the risk of residual pleural fluid after 4 weeks and the number of days to symptom improvement; however, there was no convincing evidence to support the positive effects of corticosteroids over the long term (8 weeks) on residual pleural fluid, pleural thickening, or pleural adhesions, and there was no statistical difference between the corticosteroid group and control group with respect to 7-days relief of the clinical symptoms or death from any cause. In addition, more adverse events were observed in patients who received corticosteroids than in those in the control group.
Conclusions: Our results suggest that adjunctive corticosteroid use did not improve long-term efficacy and might induce more adverse events, although the risk of residual pleural fluid at 4 weeks and the number of days to symptom improvement were reduced.
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