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Prednisone reduces TB-IRIS risk in patients with HIV
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SEATTLE — Patients with HIV had significantly less risk for clinical deterioration due to tuberculosis–related inflammation when given prednisone early in their treatment regimen in a recent study.
The placebo-controlled trial tested whether prednisone safely reduced the risk of TB–associated immune reconstitution inflammatory syndrome (TB-IRIS) in patients at high risk for the disease.
“The implications of our study are that this is the first evidence-based option for reducing the risk of TB-IRIS in high-risk patients with HIV and TB starting ART,” study researcher Graeme Meintjes, MD PhD, professor of medicine at the University of Cape Town, South Africa, said in a press conference.
“Furthermore, prednisone represents a safe … option when it’s given at the doses at which we gave it and covered by ART.”
The study included 240 patients recruited at clinics just outside Cape Town. TB-IRIS was diagnosed in 56 patients in the placebo arm and 39 in the prednisone arm. Those in the latter arm were given 40 mg of prednisone per day for the first 2 weeks and 20 mg per day for the next 2 weeks. Patients were followed intensively for 12 weeks.
The following results were reported for those patients in the placebo arm and the prednisone arm, respectively: open-label corticosteroids were prescribed as necessary to treat TB-IRIS to 34 (28.3%) vs. 16 (13.3%); 27 vs. 17 were hospitalized for all causes; grade 3 adverse events occurred in 45.4% vs. 29.4%; grade 4 adverse events occurred in 8.4% vs. 7.6%; severe AIDS–defining or invasive bacterial infections occurred in 18 vs. 11; and interruptions to ART or TB treatment occurred in 15.8% vs. 8.3% .
In addition, four patients in the placebo arm died (although only one death was attributed to TB-IRIS), vs. five patients in the prednisone arm.
Overall, the researchers found that prednisone taken in the first 4 weeks of ART reduced the risk for TB-IRIS by 30% in patients initially deemed at high risk for the condition. It also decreased the need for corticosteroids to treat TB-IRIS by 53%, they said.
Meintjes noted that prednisone was also cost effective.
“For the 4-week course in which we gave it, it cost less than $3 in total,” he said. “And it’s accessible in resource-limited settings because it’s used for many other indications such as asthma.” – by Joe Green
Reference:
Meintjes G, et al. Abstract 81LB. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 13-16, 2017; Seattle.
Disclosure: The researchers report no relevant financial disclosures.