To evaluate the efficacy and safety of adjunctive corticosteroid therapy in patients with Tuberculous Meningitis (TBM) with an emphasis on treatment duration, patient subgroups, and outcomes across different geographical settings.

The effectiveness in clinical outcomes following corticosteroid therapy in patients with TBM was still unknown. Therefore, we performed a systematic review and meta-analysis to assess the role of adjunctive corticosteroid therapy in patients with TBM.

PubMed, Google Scholar, Cochrane Library, Clinical Trials.gov, Scopus, and Embase were thoroughly searched. The standard of the included trials was evaluated using the Cochrane Risk of Bias tool. With statistical significance set at P<0.05, pooled risk ratios (RR) and their corresponding 95% confidence intervals have been calculated using RevMan version 5.4.1.

Eleven studies consisting of 1917 patients out of which 985 patients were given corticosteroids therapy. The results showed that there was significant reduction in mortality (RR = 0.84, 95% CI: 0.76–0.94, P = 0.002) and heterogeneity (I= 0%). Subgroup analysis was also performed which also showed benefits of dexamethasone use (RR = 0.87, CI: 0.77–0.97) in low income countries (RR = 0.82, CI: 0.72–0.95). However, in HIV-positive patients, corticosteroids therapy did not show reduction in mortality and was not associated with statistically significant adverse effects including gastrointestinal bleeding, visual impairment, auditory impairment, hydrocephalus or joint disorders.