Corticosteroids For Preventing Postherpetic Neuralgia-A Cochrane Systematic Review

Background: Postherpetic neuralgia is one of the most commoncomplications of herpes zoster. It may persist until death and has majorimplications for quality of life and use of healthcare resources.Corticosteroids used in acute herpes zoster have a potent anti-inflammatoryaction which should minimise nerve damage and thereby relief or prevent thepain of patients suffering from this condition.Objectives: To examine the efficacy of corticosteroids in preventingpostherpetic neuralgiaMethods: Search for randomised or quasi-randomised controlled trials forcorticosteroids for preventing postherpetic neuralgia in MEDLINE (1950 to2006), EMBASE (1980 to 2006), LILACS (1982 to 2006), the ChineseBiomedical Retrieval System (1978 to 2006) and the Cochrane Register ofControlled Trials (CENTRAL) (Cochrane Library Issue 3, 2006). Date ofmost recent search: September 2005. In addition, we tracked down thereference lists of papers related to corticosteroids in preventing postherpeticneuralgia. And we handsearched 8 important Chinese journals. Two authors(ZD,ZM) independently assessed the methodological quality of studies andextracted data. Discussion or the third person (HL) when needed resolved the disagreement. The same two authors (ZD, ZM ) assessed the methodologicalquality of each trial by recording details of the randomization method,allocation concealment, blinding, and the number of patients who were lost tofollow-up and drop-out. The following outcomes were assessed: the presenceof postherpetic neuralgia six months after the onset of the acute herpeticrash; quality of life measured with the short form 36 questionnaire after sixmonths; pain severity measured by a validated visual analogue scale ornumerical descriptive scale after three, six and 12 months; adverse eventsduring or within two weeks after stopping treatment. Data were processed byRevman4.2 from the Cochrane collaboration.Results: 36 potential trials were identified, of which 5 trials (include 767patients) were eligible. 22 trials were excluded and 9 trials are waiting to beassessed. All included five trials are randomized, double-blind,placebo-controlled parallel studies. One of our primary outcome measure wasthe presence of postherpetic neuralgia six months after the onset of the acuteherpetic rash .There was no significant difference between the corticosteroidand control groups for this outcome, the actual figure was (RR 1.55; 95%CI0.25-9.42). There was also no significant difference between thecorticosteroid plus antiviral agents and placebos plus antiviral agents groupsfor the primary outcome (RR 0.90; 95%CI 0.40—2.03). No included trialsmeasured quality of life with the short form 36 questionnaire and also notrials evaluated pain severity with a validated visual analogue scale ornumerical descriptive scale. Adverse events during or within two weeks afterstopping treatment were reported by the included 5 trials, but afterMeta-analysis,there was also no significant difference in any of seriousadverse events(death, acute cardiac insufficiency, rash diffusion, bacterialpneumonia, haematemesis) or not serious adverse events (dizzyness, nausea,vomit, hypertension, hyperglycaemia)Conclusion: There was no sufficient evidence to conclude that corticosteroids is safe or effective in the prevention of postherpetic neuralgiacurrently. More randomised controlled trials with a greater number ofparticipants are needed to determine reliably whether there is real benefit (orharm) from the use of corticosteroid therapy to prevent postherpetic neuralgia.Future trials should measure function and quality of life.