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of identified trials, contacted authors and approached pharmaceutical companies to identify additional published or unpublished data.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.

 

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.

 

摘要

背景

腎上腺皮質素用於預防皰疹後神經痛

皰疹後神經痛是帶狀皰疹常見且嚴重的併發症。腎上腺皮質素有抗發炎的效用，可能對此病症有療效。

目標

檢驗腎上腺皮質素預防皰疹後神經痛的效力。

搜尋策略

搜尋以下資料庫中，有關腎上腺皮質素預防皰疹後神經痛的隨機對照試驗及準隨機對照試驗: 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)。 最新的搜尋日期: 2006 年 9 月。

選擇標準

研究的種類： 準隨機對照試驗及隨機對照試驗。 受試者的類型： 帶狀皰疹在過去 7 天之內出現的人，不論年齡或嚴重度。 治療的類型： 所有種類的腎上腺皮質素，經由口服、肌肉注射或血管內注射，於急性期(皮疹開始出現後 1 週內)投藥者，與無治療、安慰劑者進行比較；但是不和其他治療方法比較。我們也納入比較腎上腺皮質素加上其他慣用治療和安慰劑加上其他慣用治療的臨床試驗。 評估治療結果的類型： 主要結果：皮疹出現的 6 個月後病人使否有皰疹後神經痛。 次要結果：在3、6以及12個月後使用視覺類比量表或 10 cm 量表評估疼痛程度；在6個月後使用 SF−36 量表評估生活品質；治療期間與治療結束後兩週內的不良反應。

資料收集與分析

資料由 2 位獨立的審查者收集。

主要結論

搜尋到 5 個總共包含 787 位受試者的臨床試驗。這些試驗全都是隨機、雙盲、使用安慰劑作為對照組的平行分組試驗。我們主要治療結果，是指在帶狀皰疹的皮疹出現的 6 個月後病人是否有皰疹後神經痛。在腎上腺皮質素組和對照組之間，主要治療結果並沒有顯著差別 (RR 1.27, 95% CI 0.20 to 7.97)。腎上腺皮質素加上抗病毒藥物和安慰劑加上抗病毒藥物這兩組之間，主要治療結果也沒有顯著差別(RR 0.90, 95% CI 0.40 to 2.03)。這些臨床試驗都沒有使用視覺類比量表或 10 cm 量表這類方法來評估病人疼痛的程度，而且也都沒有使用 SF−36 量表評估病患的生活品質。這5個臨床試驗都有提及治療期間至治療結束後兩個星期內的不良反應；統合分析後發現不管在嚴重的(死亡、急性心功能不全、散佈性的皮疹、細菌性肺炎、吐血)或不嚴重的(眩暈、噁心、嘔吐、高血壓、高血糖)不良反應上，使用腎上腺皮質素與否並沒有造成顯著地差異。

作者結論

沒有足夠的資料可以證實腎上腺皮質素能安全或有效地用於預防皰疹後神經痛。需要更多更大規模的隨機對照試驗來確認腎上腺皮質在預防皰疹後神經痛方面是否有實際的好處(或壞處)。爾後的臨床試驗應將病患的生活功能及生活品質納入評估。

翻譯人

本摘要由新光醫院黃心樂翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

腎上腺皮質素用於預防皰疹後神經痛： 帶狀皰疹，是一種類似水痘但是侷限在局部區域的皮疹。皰疹後神經痛是帶狀皰疹急性感染後一種最常見且令人痛苦的併發症。這種疼痛有可能持續終身。它對生活品質和醫療資源可造成相當負面的影響。腎上腺皮質素有強力的抗發炎功效，或許可以緩和神經的受損，進而減緩或預防此類疼痛。這份評論包含了 5 個臨床試驗。分析結果指出，帶狀皰疹的皮疹出現後 6 個月時，是否有皰疹後神經痛，在類固醇皮質素治療組和對照組之間，並沒有顯著差別。類固醇皮質素和安慰劑在次要治療結果和次分組的分析中，也看不出顯著差別。沒有足夠的證據可以證實腎上腺皮質素能安全或有效地用於預防皰疹後神經痛。若想可靠地指出腎上腺皮質在預防皰疹後神經痛方面有實際的好處(或壞處)，可能需要更多個有更多受試者的隨機對照試驗。爾後的臨床試驗應將病患的生活功能及生活品質納入評估。