Dexamethasone and long-term outcome of tuberculous meningitis in Vietnamese adults and adolescents.
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 wer...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2011-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3234244?pdf=render |
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| author | M Estée Török Duc Bang Nguyen Thi Hong Chau Tran Thi Bich Yen Nguyen Guy E Thwaites Thi Quy Hoang Huy Dung Nguyen Tinh Hien Tran Tran Chinh Nguyen Hoang Thi Thanh Hoang Marcel Wolbers Jeremy J Farrar |
| author_facet | M Estée Török Duc Bang Nguyen Thi Hong Chau Tran Thi Bich Yen Nguyen Guy E Thwaites Thi Quy Hoang Huy Dung Nguyen Tinh Hien Tran Tran Chinh Nguyen Hoang Thi Thanh Hoang Marcel Wolbers Jeremy J Farrar |
| author_sort | M Estée Török |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-12T22:28:58Z |
| format | Article |
| id | doaj.art-b9e6b20edca641c3ba8f9e129b2445c2 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-12T22:28:58Z |
| publishDate | 2011-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-b9e6b20edca641c3ba8f9e129b2445c22022-12-22T00:09:40ZengPublic Library of Science (PLoS)PLoS ONE1932-62032011-01-01612e2782110.1371/journal.pone.0027821Dexamethasone and long-term outcome of tuberculous meningitis in Vietnamese adults and adolescents.M Estée TörökDuc Bang NguyenThi Hong Chau TranThi Bich Yen NguyenGuy E ThwaitesThi Quy HoangHuy Dung NguyenTinh Hien TranTran Chinh NguyenHoang Thi Thanh HoangMarcel WolbersJeremy J FarrarDexamethasone 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.http://europepmc.org/articles/PMC3234244?pdf=render |
| spellingShingle | M Estée Török Duc Bang Nguyen Thi Hong Chau Tran Thi Bich Yen Nguyen Guy E Thwaites Thi Quy Hoang Huy Dung Nguyen Tinh Hien Tran Tran Chinh Nguyen Hoang Thi Thanh Hoang Marcel Wolbers Jeremy J Farrar Dexamethasone and long-term outcome of tuberculous meningitis in Vietnamese adults and adolescents. PLoS ONE |
| title | Dexamethasone and long-term outcome of tuberculous meningitis in Vietnamese adults and adolescents. |
| title_full | Dexamethasone and long-term outcome of tuberculous meningitis in Vietnamese adults and adolescents. |
| title_fullStr | Dexamethasone and long-term outcome of tuberculous meningitis in Vietnamese adults and adolescents. |
| title_full_unstemmed | Dexamethasone and long-term outcome of tuberculous meningitis in Vietnamese adults and adolescents. |
| title_short | Dexamethasone and long-term outcome of tuberculous meningitis in Vietnamese adults and adolescents. |
| title_sort | dexamethasone and long term outcome of tuberculous meningitis in vietnamese adults and adolescents |
| url | http://europepmc.org/articles/PMC3234244?pdf=render |
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