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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 1

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Forest plot of comparison: 1 Corticosteroids vs placebo or no treatment, outcome: 1.1 The presence of PHN six months after the onset of the acute herpetic rash.
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Figure 2

Forest plot of comparison: 1 Corticosteroids vs placebo or no treatment, outcome: 1.1 The presence of PHN six months after the onset of the acute herpetic rash.

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Forest plot of comparison: 1 Corticosteroids vs placebo or no treatment, outcome: 1.2 The main effect of prednisone compared with no prednisone on six months evaluation of pain (generic inverse variance).
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Figure 3

Forest plot of comparison: 1 Corticosteroids vs placebo or no treatment, outcome: 1.2 The main effect of prednisone compared with no prednisone on six months evaluation of pain (generic inverse variance).

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Forest plot of comparison: 1 Corticosteroids vs placebo, outcome: 1.3 Serious adverse events.
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Figure 4

Forest plot of comparison: 1 Corticosteroids vs placebo, outcome: 1.3 Serious adverse events.

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Forest plot of comparison: 1 Corticosteroids vs placebo, outcome: 1.4 Non‐serious adverse events.
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Figure 5

Forest plot of comparison: 1 Corticosteroids vs placebo, outcome: 1.4 Non‐serious adverse events.

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Forest plot of comparison: 2 Sub‐group analysis, outcome: 2.1 The presence of PHN six months after the onset of the acute herpetic rash.
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Figure 6

Forest plot of comparison: 2 Sub‐group analysis, outcome: 2.1 The presence of PHN six months after the onset of the acute herpetic rash.

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Comparison 1 Corticosteroids versus placebo, Outcome 1 The presence of PHN six months after the onset of the acute herpetic rash.
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Analysis 1.1

Comparison 1 Corticosteroids versus placebo, Outcome 1 The presence of PHN six months after the onset of the acute herpetic rash.

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Comparison 1 Corticosteroids versus placebo, Outcome 2 The main effect of prednisone compared with no prednisone on six months evaluation of pain (generic inverse variance).
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Analysis 1.2

Comparison 1 Corticosteroids versus placebo, Outcome 2 The main effect of prednisone compared with no prednisone on six months evaluation of pain (generic inverse variance).

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Comparison 1 Corticosteroids versus placebo, Outcome 3 Serious adverse events.
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Analysis 1.3

Comparison 1 Corticosteroids versus placebo, Outcome 3 Serious adverse events.

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Comparison 1 Corticosteroids versus placebo, Outcome 4 Non‐serious adverse events.
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Analysis 1.4

Comparison 1 Corticosteroids versus placebo, Outcome 4 Non‐serious adverse events.

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Comparison 2 Sub‐group analysis, Outcome 1 The presence of PHN six months after the onset of the acute herpetic rash.
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Analysis 2.1

Comparison 2 Sub‐group analysis, Outcome 1 The presence of PHN six months after the onset of the acute herpetic rash.

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Summary of findings for the main comparison. Corticosteroids for acute herpes zoster to prevent postherpetic neuralgia

Corticosteroids for acute herpes zoster to prevent postherpetic neuralgia

Patient or population: patients with acute herpes zoster to prevent postherpetic neuralgia
Settings: hospitals and clinics
Intervention: Corticosteroids

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Corticosteroids

Presence of PHN six months after the onset of the acute herpetic rash
clinical manifestation
Follow‐up: 6‐23 months

193 per 1000

183 per 1000
(87 to 384)

RR 0.95
(0.45 to 1.99)

114
(2 studies)

⊕⊕⊕⊝
moderate1

Serious adverse events
clinical manifestation and laboratory examination
Follow‐up: 6‐23 months

8 per 1000

13 per 1000
(3 to 42)

RR 1.65
(0.38 to 5.29)

755
(5 studies)

⊕⊕⊕⊝
moderate1

Non‐serious adverse events
clinical manifestation and laboratory examination
Follow‐up: 6‐23 months

113 per 1000

147 per 1000
(102 to 211)

RR 1.30
(0.9 to 1.87)

755
(5 studies)

⊕⊕⊕⊝
moderate1

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 There is a high risk of bias due to inadequately addressed incomplete outcome data of the Esmann 1987 trial, in which six patients were withdrawn, but the reasons and assigned groups of five cases were not specified.

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Summary of findings for the main comparison. Corticosteroids for acute herpes zoster to prevent postherpetic neuralgia
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Comparison 1. Corticosteroids versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 The presence of PHN six months after the onset of the acute herpetic rash Show forest plot

2

114

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.45, 1.99]

2 The main effect of prednisone compared with no prednisone on six months evaluation of pain (generic inverse variance) Show forest plot

1

RR Ratios (Fixed, 95% CI)

Totals not selected

3 Serious adverse events Show forest plot

5

755

Risk Ratio (M‐H, Fixed, 95% CI)

1.65 [0.51, 5.29]

4 Non‐serious adverse events Show forest plot

5

755

Risk Ratio (M‐H, Fixed, 95% CI)

1.30 [0.90, 1.87]
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Comparison 1. Corticosteroids versus placebo
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Comparison 2. Sub‐group analysis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 The presence of PHN six months after the onset of the acute herpetic rash Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Adults aged 50 years or more

2

107

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.47, 2.04]

1.2 Adults 49 years of age or less

1

6

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]
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Comparison 2. Sub‐group analysis
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