Efficacy and Safety of Corticosteroids in Tuberculous Meningitis: Systematic Review, Meta-Analysis, and Meta-Regression

Younas A.; Noor R.; Shaukat M.T.; Ijlal A.; Tariq I.; Satea M.; Almas M.S.; Jamil R.; Sherwani M.R.K.; Valverde N.N.G.; Qadri M.; Siddiqi M.; Qureshi K.; Yangi K.; Chaurasia B. · Brain and Behavior (2026) · DOI: 10.1002/brb3.71639

Resumen

Background: Tuberculous meningitis (TBM) carries a case fatality rate of up to 50% in resource-limited settings despite standard anti-tuberculosis therapy. Adjunctive corticosteroids are widely recommended, yet their effect on mortality and safety across diverse populations remains imprecisely defined. Methods: We conducted a systematic review and meta-analysis of randomized and quasi-randomized controlled trials identified through PubMed, Cochrane Library, ClinicalTrials.gov, Scopus, and Google Scholar up to May 2025. The outcomes were all-cause mortality, gastrointestinal bleeding, visual and auditory impairment, hydrocephalus, and joint disorders. Statistical heterogeneity was assessed using the I2 statistic. Certainty of evidence was assessed with the GRADE framework. Results: Eleven studies enrolling 1917 patients were included. Corticosteroids significantly reduced all-cause mortality (RR = 0.84, 95% CI: 0.76–0.94, p = 0.002) with low heterogeneity (I2 = 0%). Subgroup analysis revealed pronounced benefits in low-income countries (RR = 0.82, CI: 0.72–0.95) and dexamethasone use (RR = 0.87, CI: 0.77–0.97). In HIV-positive patients, corticosteroids did not significantly impact mortality (RR = 0.90, CI: 0.77–1.05, p = 0.18). No statistically significant increase in adverse outcomes was detected, including gastrointestinal bleeding (RR = 0.87), visual impairment (RR = 1.62), auditory impairment (RR = 0.79), hydrocephalus (RR = 0.47), or joint disorders (RR = 0.63). Conclusion: Adjunctive corticosteroids, particularly dexamethasone, significantly reduce mortality in TBM without increasing major adverse effects. The absence of benefit in HIV-positive patients highlights the need for targeted trials in this subgroup and in pediatric populations.

Instituciones: Universidad Peruana Cayetano Heredia