Corticosteroids for preventing postherpetic neuralgia
Abstract
Background
Postherpetic neuralgia is a common serious complication of herpes zoster. Corticosteroids are anti‐inflammatory and might be beneficial.
Objectives
To examine the efficacy of corticosteroids in preventing postherpetic neuralgia.
Search methods
We updated the searches for randomised controlled trials of corticosteroids for preventing postherpetic neuralgia in MEDLINE (January 1950 to February 2010), EMBASE (January 1980 to February 2010), LILACS (January 1982 to February 2010), the Chinese Biomedical Retrieval System (1978 to 2010 ) and the Cochrane Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2010). We also reviewed the bibliographies of identified trials, contacted authors and approached pharmaceutical companies to identify additional published or unpublished data.
Selection criteria
We included all randomised controlled trials involving corticosteroids given by oral, intramuscular or intravenous routes for people of all ages with herpes zoster of all degrees of severity within seven days after onset, compared with no treatment or placebo, but not with other treatments.
Data collection and analysis
Two authors identified potential articles, extracted data and assessed quality of each trial independently. Disagreement was resolved by discussion with other co‐authors.
Main results
Five trials were included with 787 participants in total. All were randomised, double‐blind, placebo‐controlled parallel group studies. No new trials were identified in the 2010 update. In the updated version we conducted a meta‐analysis of two trials, and the results showed that oral corticosteroids did not prevent postherpetic neuralgia six months after the herpes onset (RR, 0.95; 95% CI 0.45 to 1.99). The three other included trials also had similar results although their data could not be included in the meta‐analysis. Adverse events during or within two weeks after stopping treatment were reported in all five included trials. There were no significant differences in serious or non‐serious adverse events between the corticosteroids and placebo groups.
Authors' conclusions
Corticosteroids given acutely during zoster infection are ineffective in preventing postherpetic neuralgia. In people with acute herpes zoster the risks of administration do not appear to be great. Corticosteroids have been recommended to relieve the zoster‐associated pain in the acute phase of disease; if further research is designed to evaluate the efficacy of corticosteroids for herpes zoster, long‐term follow‐up should be included to observe their effect on the transition from acute pain to postherpetic neuralgia. Future trials should include measurements of function and quality of life.
PICOs
Plain language summary
Corticosteroids for preventing postherpetic neuralgia
Postherpetic neuralgia is a painful condition that is one of the most common complications of an acute herpes zoster infection. It presents as a localised rash resembling chicken pox, often called 'shingles'. Postherpetic neuralgia may persist until death and has major implications for quality of life and use of healthcare resources. Corticosteroids have a potent anti‐inflammatory action which might minimise nerve damage and thereby relieve or prevent the pain of people suffering from this condition. Five trials were included in the review. There was no significant difference between the corticosteroid and control groups in the presence of postherpetic neuralgia six months after the onset of acute herpetic rash. There was also no significant difference between the treatment groups and placebo groups in the secondary outcome analyses and subgroup analyses. It can be concluded that corticosteroids are ineffective in preventing postherpetic neuralgia. No significant adverse events were noted in patients with shingles taking prednisolone. Corticosteroids used for other indications during acute zoster infection appear to be as safe as when no infection is present.
