Corticosteroids for preventing postherpetic neuralgia.

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of identified trials, contacted authors and approached pharmaceutical companies to identify additional published or unpublished data.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