Abstract
The purpose of this systematic review was to examine the efficacy of oral corticosteroids for prevention of postherpetic neuralgia (PHN). Randomized controlled trials of patients suffering from herpes zoster comparing corticosteroids to control therapy (placebo or carbamazepine) or acyclovir were included. Three electronic databases (MEDLINE via PubMed, Web of Science and The Cochrane Library) were searched. Two authors assessed all eligible studies for risk of bias. Ninety-one references were found. After applying inclusion/exclusion criteria 7 studies were eligible for this systematic review. All 7 studies were at high risk of bias. Corticosteroids, rather than carbamazepine, protected the patients against PHN (Relative Risk [RR] = 0.543, 95% CI 0.087 to 3.376, p=0.512), however the results were not statistically significant. Additionally, a second meta-analysis showed that the use of corticosteroids does not prevent PHN compared to the use of a placebo (RR=0.990, 95% CI 0.092 to 10.663, p=0.994). Mild and reversible side effects were reported in patients taking only corticosteroids; two serious cardiovascular events were reported in the patients prescribed acyclovir and corticosteroid, though those two events were probably unrelated to the therapy. Individual studies reported quality of life improvements and reduction in the incidence and severity of pain with the addition of prednisone to acyclovir therapy; however the heterogeneity of the outcomes and comparison group prevented from performing meta-analyses on these outcomes. Due to the low number of studies, high risk of bias, heterogeneity of the outcomes and comparison groups, the evidence this systematic review provided was of low quality.
Highlights
Varicella zoster, the virus that causes the childhoodVaricella, never leaves the body once it has been introduced
The assessment of risk of bias with respect to the Randomized Controlled Trials was initially implemented independently by two authors (MA, AH) in accordance with the method described in the Cochrane Handbook for Systematic Reviews of Interventions [15]. (Table 1) The extraction data table prepared for each study included: primary outcome, in this systematic review was the incidence of postherpetic neuralgia (PHN), defined as pain lasting more than thirty days after onset of herpes zoster; secondary outcomes, reported by some of the studies included in this systematic review: 1) Pain intensity; the intensity of pain in the acute phase among the treated and control group
The two corticosteroids under study were prednisone and triamcinolone; three studies compared corticosteroid to a placebo [8, 13, 19], two compared corticosteroid to carbamazepine [9, 18] and two compared acyclovir with or without a concomitant corticosteroid [12,14] for the treatment of herpes zoster and prevention of PHN
Summary
The virus that causes the childhoodVaricella (chickenpox), never leaves the body once it has been introduced. Symptoms of shingles include pain, burning, tingling and numbness in the area around the affected nerves several days before the rash appears. These symptoms may be followed by headache, light sensitivity and flulike symptoms (usually without fever) just before or along with the start of a rash that usually lasts three to five weeks [1, 2]. Pain may continue for months or years or a lifetime and it is commonly diagnosed as postherpetic neuralgia (PHN) This chronic pain is the most common complication of herpes zoster and its prevalence increases with age. An estimated 12.5% of patients with herpes zoster aged 50 years or older developed PHN three months after zoster onset [5]
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