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Corticosteroids for preventing postherpetic neuralgia.

Ying Han1, Jingjing Zhang, Ning Chen

  • 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China. sophiehanying@gmail.com

The Cochrane Database of Systematic Reviews
|April 2, 2013
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Corticosteroids do not prevent postherpetic neuralgia (PHN) after herpes zoster infection. This review found no significant difference in adverse events between corticosteroids and placebo, suggesting they are ineffective for PHN prevention.

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Area of Science:

  • Neurology
  • Pharmacology
  • Infectious Diseases

Background:

  • Postherpetic neuralgia (PHN) is a debilitating complication of herpes zoster (shingles).
  • Corticosteroids possess anti-inflammatory properties, prompting investigation into their potential prophylactic role against PHN.
  • This systematic review is an updated analysis of randomized controlled trials (RCTs) evaluating corticosteroid efficacy for PHN prevention.

Purpose of the Study:

  • To systematically evaluate the effectiveness of corticosteroids in preventing the development of postherpetic neuralgia following herpes zoster infection.

Main Methods:

  • Comprehensive literature search of multiple databases (Cochrane, MEDLINE, EMBASE, LILACS, CBM) up to April 2012.
  • Inclusion criteria focused on RCTs comparing corticosteroids (oral, IM, IV) with placebo or no treatment within seven days of herpes zoster onset.
  • Data extraction and risk of bias assessment were performed independently by two authors; meta-analysis was conducted on relevant trials.

Main Results:

  • Five RCTs with 787 participants were included; meta-analysis of two trials (114 participants) showed moderate-quality evidence that oral corticosteroids do not prevent PHN at six months.
  • Three additional trials, generally at low risk of bias, were not included in meta-analysis due to outcome reporting limitations.
  • No significant differences in serious or non-serious adverse events were observed between corticosteroid and placebo groups across all five trials.

Conclusions:

  • Moderate-quality evidence indicates that corticosteroids administered acutely during herpes zoster infection are ineffective for preventing postherpetic neuralgia.
  • The risks associated with acute corticosteroid administration in herpes zoster patients do not appear to exceed those of placebo.
  • Future research should incorporate long-term follow-up and quality-of-life measures to fully assess corticosteroid effects on acute pain transitioning to PHN.