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Corticosteroids for treating nerve damage in leprosyVan Veen NHJ, Nicholls PG, Smith WCS, Richardus JH
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SummaryCorticosteroids for treating nerve damage in leprosyLeprosy is a chronic infectious disease. Leprosy bacteria cause damage to skin and peripheral nerves which may result in nerve function impairment and disability. Corticosteroids, especially prednisolone, are commonly used for treating nerve damage although their long-term effect is uncertain. Three randomised controlled trials were included in the review. Two of the included trials compared prednisolone with placebo. One trial treated mild sensory impairment of less than six months duration and the other trial treated nerve function impairment of 6 to 24 months duration. Twelve months after the start of treatment, there was no significant difference in nerve function improvement between people treated with prednisolone or with placebo. The third trial compared three corticosteroid regimens for severe type 1 reactions 12 months from the start of treatment. After 12 months, significantly more individuals on a three-month course of prednisolone required extra corticosteroids compared to the groups with a high-dose and low-dose regimen of five months duration. Diabetes and peptic or infected ulcer were sometimes reported as serious adverse events, but did not occur significantly more often in corticosteroid than placebo groups.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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April 18. 2007 AbstractBackgroundLeprosy causes nerve damage which can result in nerve function impairment and disability. Corticosteroids are commonly used for treating nerve damage, although the long-term effect is uncertain. ObjectivesTo assess the effects of corticosteroids on nerve damage in leprosy. Search strategyWe searched the Cochrane Neuromuscular Disease Group Register (February 2008), the Cochrane Central Register of Controlled Trials (Issue 4), MEDLINE (from January 1966 to January 2008), EMBASE (from January 1980 to January 2008 ), CINAHL (from January 1982 to January 2008), LILACS (from 1982 to January 2008). We checked reference lists of the studies identified, the Current Controlled Trials Register (www.controlled-trials.com), conference proceedings and contacted trial authors. Selection criteriaRandomised and quasi-randomised controlled trials of corticosteroids for nerve damage in leprosy. Data collection and analysisThe primary outcome was improvement in sensory and motor nerve function after one year. Secondary outcomes were improvement in nerve function after two years, change in nerve pain and tenderness, and adverse events. Two authors independently extracted data and assessed trial quality. We contacted trial authors for additional information. We collected adverse effects and cost effectiveness information from the trials and non-randomised studies. Main resultsWe included three randomised controlled trials involving 513 people. Two trials compared prednisolone with placebo. One trial treated mild sensory impairment of less than six months duration and the other trial treated nerve function impairment of 6 to 24 months duration. Both trials examined an effect twelve months from the start of treatment. There was no significant difference in nerve function improvement between people treated with prednisolone or with placebo. The third trial compared three corticosteroid regimens for severe type 1 reactions. This trial did not report the prespecified outcomes. However, after 12 months, a significantly higher proportion of individuals on a 3-month course of prednisolone required extra corticosteroids compared to the groups with a high-dose and low-dose regimen of five months duration. Diabetes and peptic or infected ulcer were sometimes reported as serious adverse events in the placebo-controlled trials, but not significantly more often in the corticosteroid than placebo groups. Authors' conclusionsCorticosteroids are used for treating acute nerve damage in leprosy, but evidence from two randomised controlled trials, treating either long-standing or mild nerve function impairment, did not show a significant long-term effect. A third trial showed significant benefit of a five month steroid regimen over a three month regimen. Further randomised controlled trials are needed to establish the effectiveness of corticosteroids and the optimal regimens and to examine new therapies. |