Details

Autor(en) / Beteiligte

• Török, M Estée
• Nguyen, Duc Bang
• Tran, Thi Hong Chau
• Nguyen, Thi Bich Yen
• Thwaites, Guy E
• Hoang, Thi Quy
• Nguyen, Huy Dung
• Tran, Tinh Hien
• Nguyen, Tran Chinh
• Hoang, Hoang Thi Thanh
• Wolbers, Marcel
• Farrar, Jeremy J
• Sotgiu, Giovanni

Titel

Dexamethasone and long-term outcome of tuberculous meningitis in Vietnamese adults and adolescents

Ist Teil von

• PloS one, 2011-12, Vol.6 (12), p.e27821-e27821

Ort / Verlag

United States: Public Library of Science

Erscheinungsjahr

2011

Quelle

Free E-Journal (出版社公開部分のみ）

Beschreibungen/Notizen

• Dexamethasone has been shown to reduce mortality in patients with tuberculous meningitis but the long-term outcome of the disease is unknown. 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. 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). 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. ClinicalTrials.gov NCT01317654.