Dexamethasone and long-term outcome of tuberculous meningitis in Vietnamese adults and adolescents.
BACKGROUND: Dexamethasone has been shown to reduce mortality in patients with tuberculous meningitis but the long-term outcome of the disease is unknown. METHODS: Vietnamese adults and adolescents with tuberculous meningitis recruited to a randomised, double-blind, placebo-controlled trial of adjun...
| Main Authors: | , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
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2011
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| _version_ | 1797092232594980864 |
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| author | Török, M Nguyen, D Tran, T Nguyen, T Thwaites, G Hoang, T Nguyen, H Tran, T Nguyen, T Hoang, H Wolbers, M Farrar, J |
| author_facet | Török, M Nguyen, D Tran, T Nguyen, T Thwaites, G Hoang, T Nguyen, H Tran, T Nguyen, T Hoang, H Wolbers, M Farrar, J |
| author_sort | Török, M |
| collection | OXFORD |
| description | BACKGROUND: Dexamethasone has been shown to reduce mortality in patients with tuberculous meningitis but the long-term outcome of the disease is unknown. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. TRIAL REGISTRATION: ClinicalTrials.gov NCT01317654. |
| first_indexed | 2024-03-07T03:43:14Z |
| format | Journal article |
| id | oxford-uuid:be992921-aa73-4cc5-ae7a-c9a1d35671dc |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T03:43:14Z |
| publishDate | 2011 |
| record_format | dspace |
| spelling | oxford-uuid:be992921-aa73-4cc5-ae7a-c9a1d35671dc2022-03-27T05:40:49ZDexamethasone and long-term outcome of tuberculous meningitis in Vietnamese adults and adolescents.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:be992921-aa73-4cc5-ae7a-c9a1d35671dcEnglishSymplectic Elements at Oxford2011Török, MNguyen, DTran, TNguyen, TThwaites, GHoang, TNguyen, HTran, TNguyen, THoang, HWolbers, MFarrar, J BACKGROUND: Dexamethasone has been shown to reduce mortality in patients with tuberculous meningitis but the long-term outcome of the disease is unknown. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. TRIAL REGISTRATION: ClinicalTrials.gov NCT01317654. |
| spellingShingle | Török, M Nguyen, D Tran, T Nguyen, T Thwaites, G Hoang, T Nguyen, H Tran, T Nguyen, T Hoang, H Wolbers, M Farrar, J Dexamethasone and long-term outcome of tuberculous meningitis in Vietnamese adults and adolescents. |
| 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 |
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