Efficacy and safety of drug therapies for treating tuberculous meningitis: a network meta-analysis
Abstract
INTRODUCTION: The optimal treatment for tuberculous meningitis (TBM) remains inconclusive. This study intends to compare the efficacy and safety of available drug therapies for treating TBM from the perspective of mortality, neurological events, and adverse events.
METHODS: PubMed (21/6/2025), Cochrane (21/6/2025), Embase (21/6/2025), and Web of Science (21/6/2025) were searched for randomized controlled trials (RCTs) of TBM. Risk of Bias 2.0 was used for the quality assessment of the included studies. R4.2.3 "gemtc" package was used for data analysis, and Stata 15.0 was utilized to assess publication bias. Odds ratios (ORs) with 95% credible intervals (95% CrIs) were calculated as effect sizes.
RESULTS: Twenty-nine RCTs involving 4,640 TBM patients were included. The results showed that when combined with the standard treatment, prednisone might reduce TBM mortality [OR (95% CrI) = 0.26 (0.07, 0.78)]; both methylprednisolone [OR (95% CrI) = 0.13 (0, 0.98)] and prednisone [OR (95% CrI) = 0.18 (0.02, 0.76)] were likely to reduce the incidence of tuberculoma and other extracranial tuberculosis; prednisolone might increase the risk of neurological events [OR (95% CrI) = 5.98 (2.03, 20.7)], while standard-dose rifampicin was less likely to cause neurological events [OR (95% CrI) = 0.25 (0.06, 0.78)]; dexamethasone might increase the incidence of gastrointestinal events [OR (95% CrI) = 1.72 (1.04, 2.91)]; levofloxacin was more likely to cause hepatic events [OR (95% CrI) = 1.79…
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: 4,640 participants or records.
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