Thalidomide, an anti-inflammatory and immunomodulatory agent, has a potential role in cases with central nervous system tuberculosis (CNS-TB) with paradoxical reactions. Although several articles have described the use of thalidomide in CNS-TB, no systematic review has been performed in this regard. Different electronic databases were searched for articles describing the use of thalidomide in patients with CNS-TB. For determining pooled estimates in the quantitative review, studies with a minimum sample size of 5 were only considered, whereas for qualitative synthesis even single case reports were included. Fixed or random effect models were used suitably depending on the degree of heterogeneity. Fourteen articles describing a total of 107 patients (98 children and 9 adults) were selected from 156 records. A favorable clinical response was observed in 89% of patients with CNS-TB who had paradoxical reactions refractory to corticosteroids. Majority of the studies used a dose of 2–6 mg/kg/day and around 24% suffered from at least one adverse effect, with a mortality of 5%. Predominant adverse effects were rash (9.5%), neuropathy (6%), and elevated liver transaminases (9.5%). Only one placebo-controlled trial has been performed till now, which showed that high-dose thalidomide has numerous adverse effects, without any clinically significant improvement as compared with placebo. While in HIV-positive patients with TB-immune reconstitution inflammatory syndrome thalidomide was helpful in around 82% of cases. Low-dose thalidomide is helpful in patients with CNS-TB who had a paradoxical reaction and unresponsive to corticosteroids. Large, randomized trials are needed to provide more concrete information regarding the safety and efficacy of thalidomide.
Supplemental Materials (DOCX 21 KB)
Address correspondence to Indar Kumar Sharawat, Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh 249203, India. E-mail: email@example.com
Disclaimer: We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.
Authors’ addresses: Prateek Kumar Panda and Indar Kumar Sharawat, Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India, E-mails: firstname.lastname@example.org and email@example.com. Pragnya Panda, Department of Neurology, King George Medical University, Lucknow, India, E-mail: firstname.lastname@example.org. Lesa Dawman, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India, E-mail: email@example.com. Rakesh Kumar Sihag, Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, India, E-mail: firstname.lastname@example.org.