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.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01317654.

• Authors: M Estée Török, Duc Bang Nguyen, Thi Hong Chau Tran, Thi Bich Yen Nguyen, Guy E Thwaites, Thi Quy Hoang, Huy Dung Nguyen, Tinh Hien Tran, Tran Chinh Nguyen, Hoang Thi Thanh Hoang, Marcel Wolbers, Jeremy J Farrar
• Journal: PloS one (PLoS One) Vol. 6 Issue 12 Pg. e27821 ( 2011) ISSN: 1932-6203 [Electronic] United States
• PMID: 22174748 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Dexamethasone

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Dexamethasone (therapeutic use)
• Female
• Follow-Up Studies
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Proportional Hazards Models
• Time Factors
• Treatment Outcome
• Tuberculosis, Meningeal (drug therapy)
• Vietnam
• Young Adult