Corticosteroids for preventing postherpetic neuralgia

He L, Zhang D, Zhou M, Zhu C

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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, a localised rash resembling chicken pox often called 'shingles'. It 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. There was insufficient evidence to conclude that corticosteroids are safe or effective in the prevention of postherpetic neuralgia. More randomised controlled trials with a greater number of participants are needed to determine reliably whether there is real benefit (or harm) from the use of corticosteroid therapy to prevent postherpetic neuralgia. Future trials should measure function and quality of life.

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).
This record should be cited as: He L, Zhang D, Zhou M, Zhu C. Corticosteroids for preventing postherpetic neuralgia. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD005582. DOI: 10.1002/14651858.CD005582.pub2.

This version first published online: January 23. 2008

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 strategy

Search for randomised or quasi-randomised controlled trials for corticosteroids for preventing postherpetic neuralgia in MEDLINE (1950 to 2006), EMBASE (1980 to 2006), LILACS (1982 to 2005), the Chinese Biomedical Retrieval System (1978 to 2006) and the Cochrane Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 3, 2006). Date of most recent search: September 2006.

Selection criteria

Types of studies: quasi-randomised or randomised controlled trials
Types of participants: people of all ages with herpes zoster of all degrees of severity within seven days after onset.
Types of interventions: all kinds of corticosteroids given by oral, intramuscular or intravenous routes during the acute stage (starting within one week of onset of the rash) compared with no treatment or placebo, but not with other treatments. We also included trials which compared corticosteroids plus routine treatment with placebo plus routine treatment.
Types of outcome measures:
Primary: the presence of postherpetic neuralgia six months after the onset of the acute herpetic rash.
Secondary: pain severity measured by a validated visual analogue scale or numerical descriptive scale after three, six and 12 months; quality of life measured with the short form 36 questionnaire after six months; adverse events during or within two weeks after stopping treatment.

Data collection and analysis

Data were extracted by two independent reviewers.

Main results

Five trials were included with altogether 787 participants. All were randomised, double-blind, placebo-controlled parallel group studies. Our primary outcome measure was the presence of postherpetic neuralgia six months after the onset of the acute herpetic rash. There was no significant difference between the corticosteroid and control groups for the primary outcome (RR 1.27, 95% CI 0.20 to 7.97). There was also no significant difference between the corticosteroid plus antiviral agents and placebo plus antiviral agents groups for the primary outcome (RR 0.90, 95% CI 0.40 to 2.03). No included trials evaluated pain severity with a validated visual analogue scale or numerical descriptive scale and also no trials measured quality of life with the Short Form 36 questionnaire. Adverse events during or within two weeks after stopping treatment were reported by all five included trials, but after meta-analysis, there was no significant difference in any serious adverse event (death, acute cardiac insufficiency, rash dissemination, bacterial pneumonia or haematemesis) or non serious adverse event (dizziness, nausea, vomiting, hypertension or hyperglycaemia).

Authors' conclusions

There was insufficient evidence to conclude that corticosteroids are safe or effective in the prevention of postherpetic neuralgia. More randomised controlled trials with a greater number of participants are needed to determine reliably whether there is real benefit (or harm) from the use of corticosteroid therapy to prevent postherpetic neuralgia. Future trials should measure function and quality of life.

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