Adjunctive linezolid in patients with tuberculous meningitis for the prevention of mortality or neurologic disability: a meta-analysis of randomized controlled trials
Abstract
Background: This systematic review aimed to evaluate the effectiveness of linezolid as an adjunct to the current tuberculous meningitis standard of care in preventing death and neurologic disability.
Methods: The MEDLINE, Embase, and CENTRAL databases were searched until 5 January 2024. We included randomized controlled trials evaluating the effectiveness of linezolid in individuals with clinically diagnosed tuberculous meningitis. For the statistical analysis, we used a Bayesian random-effects model with a weakly informative prior.
Results: Three trials were included in this review. Linezolid has a 92% probability of preventing one death per 100 treated patients (RR 0.55, 95% CrI 0.23 to 1.31; I2= 13%; n = 104 patients; low-certainty evidence), with a mean number needed to treat (NNT) of 6 patients. Further, there is an 87% probability that one poor neurologic outcome is prevented per 100 patients (RR 0.72, 95% CrI 0.40 to 1.30; I2= 22%; n = 104 patients; low-certainty evidence), with a mean NNT of 7. The risk of grade 3 or 4 adverse events was not increased with linezolid, although this is uncertain.
Conclusions: Linezolid may reduce mortality and neurologic disability in adult, HIV-positive individuals with tuberculous meningitis. Further trials should investigate ideal dosing and applicability to other populations.
Clinical trial number: Not applicable.
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 104 participants or records.
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