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• W2055353522 abstract "Take-Home MessageAlthough corticosteroids do not prevent postherpetic neuralgia, they may decrease the duration of acute zoster pain when given as a 3-week course.MethodsData SourcesThe Cochrane Neuromuscular Disease Group Specialized Register for Randomised Controlled Trials, CENTRAL, MEDLINE, Latin American and Caribbean Health Sciences Literature, EMBASE, and the Chinese Biomedical Retrieval System were searched, in addition to bibliographies of identified trials, up to April 2012. Pharmaceutical companies, study authors, and known experts in the field were also contacted to identify additional unpublished data.Study SelectionThe review was based on double-blinded randomized controlled trials of corticosteroids for preventing postherpetic neuralgia after an acute herpes zoster infection. Quasi randomized controlled trials were not included.Data Extraction and SynthesisTwo authors independently evaluated study titles and abstracts for inclusion and 3 authors reviewed selected full texts; differences were resolved by discussion. The authors used χ2 analysis to assess for heterogeneity. Risk of bias assessment took into account randomization, blinding, completeness of outcome data, selective outcome reporting, and other sources of potential bias according to the Cochrane Collaboration standard scheme. The primary outcome was the presence of postherpetic neuralgia 6 months after the onset of acute herpetic rash. Although corticosteroids do not prevent postherpetic neuralgia, they may decrease the duration of acute zoster pain when given as a 3-week course. The Cochrane Neuromuscular Disease Group Specialized Register for Randomised Controlled Trials, CENTRAL, MEDLINE, Latin American and Caribbean Health Sciences Literature, EMBASE, and the Chinese Biomedical Retrieval System were searched, in addition to bibliographies of identified trials, up to April 2012. Pharmaceutical companies, study authors, and known experts in the field were also contacted to identify additional unpublished data. The review was based on double-blinded randomized controlled trials of corticosteroids for preventing postherpetic neuralgia after an acute herpes zoster infection. Quasi randomized controlled trials were not included. Two authors independently evaluated study titles and abstracts for inclusion and 3 authors reviewed selected full texts; differences were resolved by discussion. The authors used χ2 analysis to assess for heterogeneity. Risk of bias assessment took into account randomization, blinding, completeness of outcome data, selective outcome reporting, and other sources of potential bias according to the Cochrane Collaboration standard scheme. The primary outcome was the presence of postherpetic neuralgia 6 months after the onset of acute herpetic rash. Tabled 1Estimates for potential benefit and harm with corticosteroid therapy for shingles.OutcomesEstimated Risk in ControlEstimated Risk With Corticosteroids (95% CI)Relative Risk (95% CI)No. of Studies (Participants)Quality of EvidencePresence of postherpetic neuralgia at 6 mo193/1,000183/1,000 (87–384)0.95 (0.45–1.99)2 (114)ModerateSerious adverse events8/1,00013/1,000 (3–42)1.65 (0.38–5.29)5 (755)ModerateCI, Confidence interval. Open table in a new tab CI, Confidence interval. The literature search identified 1,361 trials, of which 43 were potential randomized controlled trials and underwent full-text review. Five trials were included in the systematic review; however, 3 studies were excluded from meta-analysis for the primary outcome at 6 months: one study1Clemmensen O.J. Andersen K.E. ACTH versus prednisone and placebo in herpes zoster treatment.Clin Exp Dermatol. 1984; 9: 557-563Crossref PubMed Scopus (48) Google Scholar did not include data beyond 6 weeks, and 2 studies4Whitley R.J. Weiss H. Gnann Jr., J.W. et al.Acyclovir with and without prednisone for the treatment of herpes zoster: a randomized, placebo-controlled trial.Ann Intern Med. 1996; 125: 376-383Crossref PubMed Scopus (338) Google Scholar, 5Wood M.J. Johnson R.W. Mckendrick M.W. et al.A randomized trial of acyclovir for 7 days or 21 days with and without prednisolone for treatment of acute herpes zoster.N Engl J Med. 1994; 330: 896-900Crossref PubMed Scopus (380) Google Scholar included only pain-scale assessments during the first month after infection. Two studies2Eaglstein W.H. Katz R. Brown J.A. The effects of early corticosteroid therapy on the skin eruption and pain of herpes zoster.JAMA. 1970; 211: 1681-1683Crossref PubMed Scopus (170) Google Scholar, 3Esmann V. Geil J.P. Kroon S. et al.Prednisolone does not prevent post-herpetic neuralgia.Lancet. 1987; 2: 126-129Abstract PubMed Scopus (128) Google Scholar including 114 participants were deemed appropriate for pooling and showed no difference in the incidence of postherpetic neuralgia between treatment and placebo groups at 6 months. However, one of these trials3Esmann V. Geil J.P. Kroon S. et al.Prednisolone does not prevent post-herpetic neuralgia.Lancet. 1987; 2: 126-129Abstract PubMed Scopus (128) Google Scholar had a high risk of bias because 6 of the 79 subjects withdrew from the study and the reasons were not specified. Only 2 trials explicitly reported the absence of any serious adverse events; adverse events reported in the other trials included cardiac insufficiency, 3Esmann V. Geil J.P. Kroon S. et al.Prednisolone does not prevent post-herpetic neuralgia.Lancet. 1987; 2: 126-129Abstract PubMed Scopus (128) Google Scholarmyocardial infarction,5Wood M.J. Johnson R.W. Mckendrick M.W. et al.A randomized trial of acyclovir for 7 days or 21 days with and without prednisolone for treatment of acute herpes zoster.N Engl J Med. 1994; 330: 896-900Crossref PubMed Scopus (380) Google Scholar pneumonia,4Whitley R.J. Weiss H. Gnann Jr., J.W. et al.Acyclovir with and without prednisone for the treatment of herpes zoster: a randomized, placebo-controlled trial.Ann Intern Med. 1996; 125: 376-383Crossref PubMed Scopus (338) Google Scholar, 5Wood M.J. Johnson R.W. Mckendrick M.W. et al.A randomized trial of acyclovir for 7 days or 21 days with and without prednisolone for treatment of acute herpes zoster.N Engl J Med. 1994; 330: 896-900Crossref PubMed Scopus (380) Google Scholar chest infection,4Whitley R.J. Weiss H. Gnann Jr., J.W. et al.Acyclovir with and without prednisone for the treatment of herpes zoster: a randomized, placebo-controlled trial.Ann Intern Med. 1996; 125: 376-383Crossref PubMed Scopus (338) Google Scholar hematemesis,4Whitley R.J. Weiss H. Gnann Jr., J.W. et al.Acyclovir with and without prednisone for the treatment of herpes zoster: a randomized, placebo-controlled trial.Ann Intern Med. 1996; 125: 376-383Crossref PubMed Scopus (338) Google Scholar and death from other unspecified causes.4Whitley R.J. Weiss H. Gnann Jr., J.W. et al.Acyclovir with and without prednisone for the treatment of herpes zoster: a randomized, placebo-controlled trial.Ann Intern Med. 1996; 125: 376-383Crossref PubMed Scopus (338) Google Scholar Additional comment was made on the short-term outcomes included in these 2 studies. One trial5Wood M.J. Johnson R.W. Mckendrick M.W. et al.A randomized trial of acyclovir for 7 days or 21 days with and without prednisolone for treatment of acute herpes zoster.N Engl J Med. 1994; 330: 896-900Crossref PubMed Scopus (380) Google Scholar with 359 participants showed significant reduction in pain at 2 and 3 weeks among patients who received corticosteroids. The other trial,4Whitley R.J. Weiss H. Gnann Jr., J.W. et al.Acyclovir with and without prednisone for the treatment of herpes zoster: a randomized, placebo-controlled trial.Ann Intern Med. 1996; 125: 376-383Crossref PubMed Scopus (338) Google Scholar with 201 participants, reported benefit after 1 month with respect to time to cessation of acute neuritis, time to return of uninterrupted sleep, time to return to usual daily activity, and time to total cessation of analgesic therapy. Acute herpes zoster infection, or shingles, has an estimated lifetime incidence of 10% to 20%.5Wood M.J. Johnson R.W. Mckendrick M.W. et al.A randomized trial of acyclovir for 7 days or 21 days with and without prednisolone for treatment of acute herpes zoster.N Engl J Med. 1994; 330: 896-900Crossref PubMed Scopus (380) Google Scholar, 6Stankus S.J. Dlugopolski M. Packer D. Management of herpes zoster (shingles) and postherpetic neuralgia.Am Fam Physician. 2000; 61 (2447-2448): 2437-2444PubMed Google Scholar Of individuals affected, approximately 40% present with severe pain. Postherpetic neuralgia, defined as pain persisting at least 120 days after disease onset, is the most debilitating complication of shingles,4Whitley R.J. Weiss H. Gnann Jr., J.W. et al.Acyclovir with and without prednisone for the treatment of herpes zoster: a randomized, placebo-controlled trial.Ann Intern Med. 1996; 125: 376-383Crossref PubMed Scopus (338) Google Scholar affecting approximately 20% of patients postinfection. Treatment of herpes zoster has 3 primary objectives: (1) treat the acute viral infection, (2) treat the acute pain associated with the infection, and (3) prevent postherpetic neuralgia. Antiviral agents, corticosteroids, and analgesics have all been used to accomplish these objectives. Though corticosteroids have commonly been prescribed, there has been a lack of consensus on their efficacy in preventing postherpetic neuralgia. Although this systematic review provides moderate-grade evidence that corticosteroids do not prevent postherpetic neuralgia, analysis of secondary outcomes suggests that a 3-week tapered dose of oral corticosteroids may reduce the duration of pain in the acute phase of shingles." @default.
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• W2055353522 title "Do Corticosteroids Prevent Postherpetic Neuralgia?" @default.
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