Quelle:
Medline Abstract
Vorbeugung/Prophylaxe einer Herpes-zoster (Gürtelrose)-Neuralgie:
Nach dem Abheilen einer Herpes-zoster-Infektion kommt
es häufig zu lang anhaltenden und gelegentlich sehr starken Nervenschmerzen
- die Ärzte sprechen von einer Herpes-zoster Neuralgie.
Seit langer Zeit wird unter Experten diskutiert, ob eine
Corticosteroid-Prophylaxe das Auftreten dieser Neuralgien verhindern,
oder zumindest vermindern kann. Um diese die Patienten stark belastende
Komplikation möglichst zu verhindern, wird daher gelegentlich
eine Corticosteroid (Kortison)-Therapie durchgeführt. Nun zeigt
eine von der renommierten
Cochrane Library durchgeführte Metaanalyse der vorhandenen
wissenschaftlichen Untersuchungen, dass es bisher keine überzeugenden
Beweise für die Wirksamkeit und die Sicherheit dieser umstrittenen
Vorbeugemaßnahme gibt.
Die
vollständige englischsprachige Kurzversion dieser Studie (sog.
MEDLINE Abstract) finden Sie hier
He
L, et al. Corticosteroids for preventing postherpetic neuralgia.
Cochrane Database Syst Rev. 2008;1:CD005582
Abstract
Background Postherpetic neuralgia is a common serious complication
of herpes zoster.Corticosteroids are anti-inflammatory andmight
be beneficial.
Objectives
To examine the efficacy of corticosteroids in preventing postherpetic
neuralgia.
Search
strategy Search for randomised or quasi-randomised controlled
trials for corticosteroids for preventing postherpetic neuralgia
in MEDLINE (1950 to 2006), EMBASE (1980 to 2006), LILACS (1982
to 2005), the Chinese Biomedical Retrieval System (1978 to 2006)
and the Cochrane Register of Controlled Trials (CENTRAL) (Cochrane
Library Issue 3, 2006). Date of most recent search: September
2006. Selection criteria Types of studies: quasi-randomised or
randomised controlled trials Types of participants: people of
all ages with herpes zoster of all degrees of severity within
seven days after onset. Types of interventions: all kinds of corticosteroids
given by oral, intramuscular or intravenous routes during the
acute stage (starting within one week of onset of the rash) compared
with no treatment or placebo, but not with other treatments. We
also included trials which compared corticosteroids plus routine
treatment with placebo plus routine treatment.
Types
of outcome measures: Primary: the presence of postherpetic
neuralgia six months after the onset of the acute herpetic rash.
Secondary: pain severity measured by a validated visual analogue
scale or numerical descriptive scale after three, six and 12 months;
quality of lifemeasured with the short form 36 questionnaire after
six months; adverse events during or within two weeks after stopping
treatment. Data collection and analysis Data were extracted by
two independent reviewers. Main results Five trials were included
with altogether 787 participants. All were randomised, double-blind,
placebo-controlled parallel group studies. Our primary outcome
measure was the presence of postherpetic neuralgia six months
after the onset of the acute herpetic rash.
There
was no significant difference between the corticosteroid and control
groups for the primary outcome (RR 1.27, 95% CI 0.20 to 7.97).
There was also no significant difference between the corticosteroid
plus antiviral agents and placebo plus antiviral agents groups
for the primary outcome (RR 0.90, 95% CI 0.40 to 2.03).
No included trials evaluated pain severity with a validated visual
analogue scale or numerical descriptive scale and also no trials
measured quality of life with the Short Form 36 questionnaire.
Adverse events during or within two weeks after stopping treatment
were reported by all five included trials, but after meta-analysis,
there was no significant difference in any serious adverse event
(death, acute cardiac insufficiency, rash dissemination, bacterial
pneumonia or haematemesis) or non serious adverse event (dizziness,
nausea, vomiting, hypertension or hyperglycaemia).
Authors’
conclusions There was insufficient evidence to conclude that
corticosteroids are safe or effective in the prevention of postherpetic
neuralgia. More randomised controlled trials with a greater number
of participants are needed to determine reliably whether there
is real benefit (or harm) from the use of corticosteroid therapy
to prevent postherpetic neuralgia. Future trials should measure
function and quality of life.
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