From the Guidelines
Adjunctive corticosteroids should not be used routinely in the treatment of patients with pericardial tuberculosis, but may be considered in select cases with high risk of inflammatory complications, as suggested by the most recent guidelines 1. The use of corticosteroids in the treatment of tuberculous pericarditis has been a topic of debate, with earlier studies suggesting a potential benefit in reducing mortality and morbidity 1. However, a more recent placebo-controlled randomized clinical trial with 1400 participants did not find a significant difference in the combined primary endpoint of mortality, cardiac tamponade, or constrictive pericarditis between patients treated with adjunctive corticosteroids versus placebo 1. Some key points to consider in the treatment of tuberculous pericarditis include:
- A 6-month regimen of anti-tuberculosis therapy is adequate for patients with pericardial tuberculosis 1.
- Selective use of glucocorticoids may be appropriate in patients with large pericardial effusions, high levels of inflammatory cells or markers in pericardial fluid, or early signs of constriction 1.
- Patients should be monitored for potential steroid side effects, including hyperglycemia, hypertension, and increased susceptibility to infections.
- Early diagnosis and prompt initiation of anti-TB therapy are crucial for optimal outcomes, and pericardiectomy may be necessary in cases of constrictive pericarditis despite medical therapy. It is essential to weigh the potential benefits and risks of corticosteroid use in each individual case, considering factors such as the severity of disease, presence of comorbidities, and potential for adverse effects 1.
From the Research
Role of Steroids in TB Pericarditis
- The use of corticosteroids as an adjunct therapy in the treatment of tuberculous (TB) pericarditis has been investigated in several studies 2, 3, 4, 5.
- A study published in 2004 found that prednisolone reduced the overall death rate and substantially reduced the risk of death from pericarditis in patients with TB pericarditis 3.
- Another study published in 2013 aimed to assess the effectiveness and safety of prednisolone and Mycobacterium w immunotherapy in reducing mortality and morbidity in patients with TB pericardial effusion 4.
- The use of corticosteroids in TB pericarditis is recommended in cases where there are significant systemic symptoms or a particularly large effusion 5.
- The usual dose of prednisone required is 40-60 mg orally daily for 4-6 weeks, with tapering doses subsequent to this 5.
Benefits and Risks of Steroid Therapy
- Adjunct therapy with corticosteroids may be beneficial in reducing mortality and morbidity in patients with TB pericarditis 3, 4, 5.
- However, corticosteroid therapy may also pose risks, such as immune suppression and interaction with other medications 6, 5.
- The benefits and risks of steroid therapy should be carefully considered in each individual case, and the decision to use corticosteroids should be made on a case-by-case basis 5.
Comparison with Other Treatments
- Colchicine has been investigated as an alternative treatment for recurrent pericarditis, but its effectiveness in TB pericarditis is unclear 2, 6.
- A study published in 1992 found that colchicine was effective in treating recurrent steroid-dependent pericarditis in a patient with post-myocardial-infarction syndrome 6.
- However, another study published in 2016 found no demonstrable benefit with the use of colchicine in preventing pericardial constriction in patients with TB pericarditis 2.