Interventions for treating tuberculous pericarditis

September 14, 2017

Researchers from South Africa and Canada have carried out a Cochrane review update to assess the safety and effectiveness of corticosteroids for treating tuberculous pericarditis.

Tuberculosis (TB) infection of the pericardium, the membrane around the heart, is not common but can restrict the function of the heart and is fatal in some cases. Current treatment involves doctors prescribing anti-TB drugs for six months, draining fluid from the pericardium or removing it in some situations, and in some cases are prescribed to reduce inflammation. However, there has been some concern that steroids have the potential to cause harm to patients with HIV, a common TB co-infection.

The review authors included seven trials, six looking at the use of corticosteroids and the other at different treatments. All trials were based in sub-Saharan Africa and included 1959 participants in total.

"Given the seriousness of TB pericarditis it was important that we were able to assess the effectiveness of using corticosteroids as a treatment," said Professor Charles Shey Wiysonge, Director of Cochrane South Africa and lead author of the review, "it was also especially important to look at their safety in cases of HIV coinfections, as there has previously been an impression that treatment could cause a rise in HIV-related cancers."

The review authors found that in people without HIV, corticosteroids drugs may reduce the number of people dying overall by 20 percent, as well as probably reducing deaths from pericarditis, although the confidence intervals include the possibility of both large beneficial effects and small increases in harm. The results also show that in HIV-positive patients, corticosteroids may reduce constriction of the pericardium membrane, but the confidence intervals include the possibility of both large beneficial effects and small increases in harm.

"This systematic review, which stratified patients into HIV-positive and HIV-negative participants and excluded those who received dual immunotherapy with corticosteroids and Mycobacterium indicus pranii, showed promising effects of corticosteroids on major outcomes but generally the confidence intervals include the possibility of both large beneficial effects and small increases in harm, and there was no evidence of an increase in cancer" added Professor Bongani Mayosi, senior author of the review and lead author of the largest trial carried out on this topic. The patients on a combination of corticosteroids and Mycobacterium indicus pranii were excluded from the analysis because of the possibility of an interaction between the two agents resulting in the increased incidence of cancer in this group.

Explore further: Updated Cochrane Review: Corticosteroids for managing tuberculous meningitis

More information: Charles S Wiysonge et al. Interventions for treating tuberculous pericarditis, Cochrane Database of Systematic Reviews (2017). DOI: 10.1002/14651858.CD000526.pub2

Related Stories

Updated Cochrane Review: Corticosteroids for managing tuberculous meningitis

May 3, 2016
The Cochrane Infectious Diseases Group (CIDG) have carried out a review update to evaluate the effects of corticosteroids being used alongside anti-tuberculosis medication to treat people suffering from tuberculous meningitis.

Old bones vulnerable to long-term use of oral corticosteroids

April 20, 2017
A review of data by University of South Australia researchers has found many older people taking oral corticosteroids long-term are not having the recommended bone density tests or fracture prevention therapy, leaving them ...

Inhaled steroids may increase pneumonia risk in people with asthma

April 20, 2017
Use of inhaled corticosteroids was linked with an increased risk of pneumonia in a study of individuals with asthma.

Review supports early multimodal Tx for infantile hemangioma

May 17, 2017
(HealthDay)—Early multimodality treatment seems to achieve best results for children with infantile hemangiomas of the nose, according to research published online May 11 in JAMA Facial Plastic Surgery.

Steroids may do more harm than good in some cases of severe asthma

July 6, 2017
Researchers from the University of Pittsburgh Schools of the Health Sciences and UPMC have uncovered the molecular mechanism underlying corticosteroid resistance in severe asthma. The new findings have important clinical ...

Asthma drugs suppress growth

July 16, 2014
Corticosteroid drugs that are given by inhalers to children with asthma may suppress their growth, evidence suggests. Two new systematic reviews published in The Cochrane Library focus on the effects of inhaled corticosteroid ...

Recommended for you

Gene immunotherapy protects against multiple sclerosis in mice

September 21, 2017
A potent and long-lasting gene immunotherapy approach prevents and reverses symptoms of multiple sclerosis in mice, according to a study published September 21st in the journal Molecular Therapy. Multiple sclerosis is an ...

New academic study reveals true extent of the link between hard water and eczema

September 21, 2017
Hard water damages our protective skin barrier and could contribute to the development of eczema, a new study has shown.

Exposure to pet and pest allergens during infancy linked to reduced asthma risk

September 19, 2017
Children exposed to high indoor levels of pet or pest allergens during infancy have a lower risk of developing asthma by 7 years of age, new research supported by the National Institutes of Health reveals. The findings, published ...

Cholesterol-like molecules switch off the engine in cancer-targeting 'Natural Killer' cells

September 18, 2017
Scientists have just discovered how the engine that powers cancer-killing cells functions. Crucially, their research also highlights how that engine is fuelled and that cholesterol-like molecules, called oxysterols, act as ...

MicroRNA helps cancer evade immune system

September 18, 2017
The immune system automatically destroys dysfunctional cells such as cancer cells, but cancerous tumors often survive nonetheless. A new study by Salk scientists shows one method by which fast-growing tumors evade anti-tumor ...

'Exciting' discovery on path to develop new type of vaccine to treat global viruses

September 15, 2017
Scientists at the University of Southampton have made a significant discovery in efforts to develop a vaccine against Zika, dengue and Hepatitis C viruses that affect millions of people around the world.

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.