Corticosteroids for tuberculous pleurisy

  • Review
  • Intervention




Corticosteroids used in addition to antituberculous therapy have been reported to benefit people with tuberculous pleurisy. However, research findings are inconsistent, raising doubt as to whether such treatment is worthwhile. Concern also exists regarding the potential adverse effects of corticosteroids, especially in HIV-positive people.


To evaluate the effects of adding corticosteroids to drug regimens for tuberculous pleural effusion.

Search methods

In May 2007, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2007, Issue 2), MEDLINE, EMBASE, LILACS, Current Controlled Trials, and reference lists of articles.

Selection criteria

Randomized and quasi-randomized controlled trials comparing any corticosteroid with no treatment, placebo, or other active treatment (both groups should receive the same antituberculous drug regimen) in people diagnosed with tuberculous pleurisy.

Data collection and analysis

Two authors independently assessed trial methodological quality and extracted data. Data were analysed using relative risks (RR) and mean difference (MD) with 95% confidence intervals (CI). The fixed-effect model was applied in the absence of statistically significant heterogeneity.

Main results

Six trials with 633 participants met the inclusion criteria; one trial included only HIV-positive people. Compared to control, corticosteroid use was associated with less residual pleural fluid at four weeks (RR 0.76, 95% CI 0.62 to 0.94; 394 participants, 3 trials) and reduced pleural thickening (RR 0.69, 95% CI 0.51 to 0.94; 309 participants, 4 trials). We found no evidence of an effect of corticosteroids on death from any cause (194 participants, 1 trial), respiratory function (191 participants, 2 trials), residual pleural fluid at eight weeks (399 participants, 4 trials), or pleural adhesions (123 participants, 2 trials). Although discontinuation of treatment due to adverse events was more frequent in participants receiving corticosteroids than placebo (RR 2.80, 95% CI 1.12 to 6.98; 586 participants, 6 trials), the effects were generally mild. The risk of Kaposi sarcoma may be increased in HIV-positive people receiving corticosteroids (RR 13.00, 95% CI 0.74 to 227.63; 194 participants, 1 trial).

Authors' conclusions

There are insufficient data to support evidence-based recommendations regarding the use of adjunctive corticosteroids in people with tuberculous pleurisy. Randomized controlled trials that are sufficiently powered to evaluate the effects of corticosteroids on both morbidity and mortality are needed. The effects of corticosteroids on HIV-related complications, such as Kaposi sarcoma, should be assessed in people co-infected with HIV.








2007年5月我們搜尋Cochrane Infectious Diseases Group Specialized Register, CENTRAL(Cochrane Library 2007, Issue 2) 、MEDLINE、EMBASE、LILACS、Current Controlled Trials,以及文章的參考資料清單。






共有包含了633名參與者的6項試驗符合了收集的標準;有1項試驗只包含了對愛滋病毒呈現陽性反應的人們。跟對照組比較起來,在4週的時候,使用皮質類固醇的患者會顯示出殘餘的胸腔積液變得較少(RR 0.76,95% CI 0.62到0.94;394名參與者,3份試驗),而且胸膜增厚的情況也減少了(RR 0.69,95% CI 0.51到0.94;309 名參與者,4份試驗)。我們並沒有發現到任何證據顯示皮質類固醇與任何成因所造成的死亡(194名參與者,共1份試驗)、呼吸功能(191名參與者,共2份試驗)、在8週時的剩餘胸腔積液(399名參與者,共4份試驗),或是胸腔沾黏(123名參與者,共2份試驗)等狀況有關。跟安慰劑比較起來,對於接受了皮質類固醇類藥物的參與者而言,雖然因為不良反應而使得治療無法連續的情況變得比較頻繁(RR 2.80,95% CI 1.12到6.98;586名參與者,共6份試驗),但是這樣的影響通常不大。愛滋病毒呈現陽性反應且又接受皮質類固醇類藥物的人們Kaposi肉瘤的風險可能會增加(RR 13.00,95% CI 0.74到227.63;194名參與者,共1項試驗)。




此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。



Plain language summary

No clear evidence that corticosteroids are effective for tuberculous

Tuberculous pleural effusion results from tuberculous infection of the membrane covering of the lungs. This results in a build up of fluid around the lung that impairs breathing and may lead to restriction of lung function in the long term. Some clinicians believe that corticosteroids used in combination with antituberculous drugs can help to prevent these complications. We found no clear evidence supporting the use of corticosteroids in people with tuberculous pleural effusion, regardless of HIV status. However, only one trial evaluated the balance between benefit and harm of corticosteroids in people infected with HIV.