Corticosteroids as an adjunct to tuberculosis therapy

ABSTRACT

Introduction: Inflammation, or the prolonged resolution of inflammation, contributes to death from tuberculosis. Interest in inflammatory mechanisms and the prospect of beneficial immune modulation as an adjunct to antibacterial therapy has revived and the concept of host directed therapies has been advanced. Such renewed attention has however, overlooked the experience of such therapy with corticosteroids.

Areas covered: The authors conducted literature searches and evaluated randomized clinical trials, systematic reviews and current guidelines and summarize these findings. They found evidence of benefit in meningeal and pericardial tuberculosis in HIV-1 uninfected persons, but less so in those HIV-1 coinfected and evidence of harm in the form of opportunist malignancy in those not prescribed antiretroviral therapy. Adjunctive corticosteroids are however of benefit in the treatment and prevention of paradoxical HIV-tuberculosis immune reconstitution inflammatory syndrome.

Expert commentary: Further high-quality clinical trials and experimental medicine studies are warranted and analysis of materials arising from such studies could illuminate ways to improve corticosteroid efficacy or identify novel pathways for more specific intervention.

KEYWORDS:

• Tuberculosis
• corticosteroid
• drug therapy
• tuberculous meningitis
• tuberculous pericarditis

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has received funding from Francis Crick Institute via Cancer Research UK [FC00101218]; United Kingdom Medical Research Council [FC00110218, MR/R008922/1]; Wellcome [FC00110218, 104803, 203135]; European and Developing Countries Clinical Trials Partnership [SRIA2015-1065]; Foundation for the National Institutes of Health [WILKI16PTB]; U.S. Department of Health and Human Services; National Institutes of Health; National Institute of Allergy and Infectious Diseases [U01AI115940], South African Medical Research Council [National Health Scholarship Programme]; National Research Foundation of South Africa [IFR150414117178] grant number 96841 .