Steroids may help reduce deaths from all types of tuberculosis

March 12, 2013, St. George's University of London

The routine use of steroids to treat tuberculosis may help reduce deaths from all types of the disease, according to a new review of existing research.

Each year there are 8.7million cases of TB worldwide, and it causes 1.4million deaths. The most common form of the disease () affects the lungs, but there are many other forms and it can affect almost all the body's organs.

Currently, are routinely used only for certain types of TB – each of which affects a different organ system – where they have been proven effective as a secondary treatment alongside anti-TB drugs. Exactly how steroids help combat TB is not known, but they are believed to counter the tissue-damaging effect of the caused by the disease.

This latest research – which summarised the findings of existing studies from 1955 to 2012 on the effect of steroids on all types of TB – found that there were 17 per cent less deaths overall among patients taking steroids than those who were not. The study did not demonstrate a difference in death rates between different forms of TB.

The researchers say their findings suggest that steroids could work in a systemic way that is similar for all forms of the disease. Nevertheless, they say further studies are required before steroids should be recommended for all TB patients. Such studies should investigate if the reduced death rate is seen when looking at current only, in studies with greater numbers of patients, and if the benefits of routinely prescribing steroids for all TB would outweigh the risk of harmful side effects. Potential side effects of steroid use include increased vulnerability to other infections.

The research was carried out by a team at St George's, University of London, in partnership with Newcastle University, the University of Liverpool and the Liverpool School of Tropical Medicine. It has been published in The .

The researchers analysed results from 41 previous major TB trials on the efficacy of corticosteroids – drugs based on hormones found in the adrenal gland, which are used to reduce inflammation. They looked at trials involving the five common forms of TB for which steroid trials had been conducted. The types of TB were pericarditis (affecting the heart), meningitis (the brain and spinal cord), peritonitis (the abdomen) and pleurisy (the membranes surrounding the lungs). In total, they examined information on 3,560 patients who took steroids and 2,982 who did not. The types of steroids, the doses and the duration of treatment varied.

As the trials took place over 57 years, the anti-TB combination drug regimens also varied. Rifampicin – the most effective and now most widely used anti-TB drug – was not involved in any of the 19 trials held before 1983. All but one of the trials involving pulmonary TB were held pre-rifampicin. However, the researchers did not observe any difference in of patients taking steroids between current and older treatments.

Lead author Professor Julia Critchley from St George's, University of London said: "There has been debate among clinicians on whether steroids should be routinely prescribed for . At the moment they're used in a specific way to target certain organ systems, and they have been proven effective in treating the meningitis and pericarditis forms of TB, but our findings suggest that the effects in one organ system might well apply to the others in terms of an overall reduction in deaths from the disease. There could therefore be benefit in using steroids for all tuberculosis."

But Professor Critchley added: "The quality and amount of evidence we had for each type of TB varied, and most of the trials took place before the emergence of drugs resistant to anti-TB therapies, so we need to do further studies to build up a more comprehensive and up-to-date picture."

Fiona Young, a research associate in public health from Newcastle University who contributed to the study, said: "The efficacy of steroid treatment for all forms of tuberculosis suggests there is an effect on death for TB of all types, although numbers were small.

"Tuberculosis presents a major public health challenge and it's important that we determine the effects of steroids in an era where drug resistance and HIV impact upon tuberculosis treatment outcomes."

Explore further: New tuberculosis research movement needed

More information: Prof Julia A Critchley DPhil, Fiona Young PhD, Lois Orton PhD, Prof Paul Garner MD, Corticosteroids for prevention of mortality in people with tuberculosis: a systematic review and meta-analysis, The Lancet Infectious Diseases, Volume 13, Issue 3, Pages 223 - 237, March 2013, doi:10.1016/S1473-3099(12)70321-3 http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2812%2970321-3/fulltext

Related Stories

New tuberculosis research movement needed

November 30, 2011
In this week's PLoS Medicine, Christian Lienhardt from the WHO in Geneva, Switzerland and colleagues announce that the Stop TB Partnership and the WHO Stop TB Department have launched the TB Research Movement.

S.Africa conducts trials for shorter TB treatment

March 30, 2012
South African researchers said Friday they were conducting medical trials to shorten the duration of tuberculosis treatment to make it easier for patients to complete the full regimen.

Scientists to study the role genes play in treating tuberculosis

October 25, 2012
The University of Liverpool has been awarded funding to determine whether differences in our genes determine how patients respond to drugs used to treat Tuberculosis (TB) in Sub-Saharan Africa.

Management of TB cases falls short of international standards

February 9, 2012
The management of tuberculosis cases in the European Union (EU) is not meeting international standards, according to new research.

Recommended for you

Research finds new mechanism that can cause the spread of deadly infection

April 20, 2018
Scientists at the University of Birmingham have discovered a unique mechanism that drives the spread of a deadly infection.

Selection of a pyrethroid metabolic enzyme CYP9K1 by malaria control activities

April 20, 2018
Researchers from LSTM, with partners from a number of international institutions, have shown the rapid selection of a novel P450 enzyme leading to insecticide resistance in a major malaria vector.

Study predicts 2018 flu vaccine will have 20 percent efficacy

April 19, 2018
A Rice University study predicts that this fall's flu vaccine—a new H3N2 formulation for the first time since 2015—will likely have the same reduced efficacy against the dominant circulating strain of influenza A as the ...

Low-cost anti-hookworm drug boosts female farmers' physical fitness

April 19, 2018
Impoverished female farm workers infected with intestinal parasites known as hookworms saw significant improvements in physical fitness when they were treated with a low-cost deworming drug. The benefits were seen even in ...

Zika presents hot spots in brains of chicken embryos

April 19, 2018
Zika prefers certain "hot spots" in the brains of chicken embryos, offering insight into how brain development is affected by the virus.

Super-superbug clones invade Gulf States

April 18, 2018
A new wave of highly antibiotic resistant superbugs has been found in the Middle East Gulf States, discovered by University of Queensland researchers.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.