Corticosteroids for treating nerve damage in leprosy

A Cochrane Review

Natasja H. J. Van Veen, Peter G Nicholls, William Cairns Stewart Smith, Jan Hendrik Richardus

Research output: Contribution to journalLiterature review

27 Citations (Scopus)

Abstract

Objective Corticosteroids are commonly used for treating nerve damage ill leprosy. We assessed the effectiveness of corticosteroids for treating nerve damage due to leprosy.

Methods A systematic search was undertaken to identify randomised controlled trials (RCTs) comparing corticosteroids with placebo or with no treatment. Two authors independently assessed quality and extracted data. Where it was not possible to perform a meta-analysis, the data for each trial was summarised.

Results Three RCTs involving 513 people were found. Two trials compared prednisolone with placebo. One trial treated mild sensory impairment of less than 6 months duration and the other trial treated nerve function impairment of 6 to 24 months duration. Both trials examined nerve function improvement 12 months from the start of treatment, but found no significant difference between the two groups. The third trial compared three corticosteroid regimens for severe type I reactions. After 12 months, a significantly higher proportion of individuals oil a 3 month course required extra corticosteroids compared to the groups with a high-dose and low-dose regimen of 5 months duration. Diabetes and peptic or infected ulcers were not significantly more often reported in the corticosteroid compared to the placebo group.

Conclusion Evidence from RCTs does not show a significant long-term effect for either long-standing nerve function impairment or mild sensory impairment. A 5 month corticosteroid regimen was significantly more beneficial than a 3 month corticosteroid regimen. Further RCTs are needed to establish the effectiveness and optimal regimens of corticosteroids and to examine new therapies.

Original languageEnglish
Pages (from-to)361-371
Number of pages11
JournalLeprosy Review
Volume79
Issue number4
Publication statusPublished - Dec 2008

Keywords

  • type-1 reversal reactions
  • function impairment
  • prospective cohort
  • steroid treatment
  • ulnar neuritis
  • trial
  • management
  • prednisolone
  • prophylaxis
  • prevention

Cite this

Van Veen, N. H. J., Nicholls, P. G., Smith, W. C. S., & Richardus, J. H. (2008). Corticosteroids for treating nerve damage in leprosy: A Cochrane Review. Leprosy Review, 79(4), 361-371.

Corticosteroids for treating nerve damage in leprosy : A Cochrane Review. / Van Veen, Natasja H. J.; Nicholls, Peter G; Smith, William Cairns Stewart; Richardus, Jan Hendrik.

In: Leprosy Review, Vol. 79, No. 4, 12.2008, p. 361-371.

Research output: Contribution to journalLiterature review

Van Veen, NHJ, Nicholls, PG, Smith, WCS & Richardus, JH 2008, 'Corticosteroids for treating nerve damage in leprosy: A Cochrane Review', Leprosy Review, vol. 79, no. 4, pp. 361-371.
Van Veen NHJ, Nicholls PG, Smith WCS, Richardus JH. Corticosteroids for treating nerve damage in leprosy: A Cochrane Review. Leprosy Review. 2008 Dec;79(4):361-371.
Van Veen, Natasja H. J. ; Nicholls, Peter G ; Smith, William Cairns Stewart ; Richardus, Jan Hendrik. / Corticosteroids for treating nerve damage in leprosy : A Cochrane Review. In: Leprosy Review. 2008 ; Vol. 79, No. 4. pp. 361-371.
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abstract = "Objective Corticosteroids are commonly used for treating nerve damage ill leprosy. We assessed the effectiveness of corticosteroids for treating nerve damage due to leprosy.Methods A systematic search was undertaken to identify randomised controlled trials (RCTs) comparing corticosteroids with placebo or with no treatment. Two authors independently assessed quality and extracted data. Where it was not possible to perform a meta-analysis, the data for each trial was summarised.Results Three RCTs involving 513 people were found. Two trials compared prednisolone with placebo. One trial treated mild sensory impairment of less than 6 months duration and the other trial treated nerve function impairment of 6 to 24 months duration. Both trials examined nerve function improvement 12 months from the start of treatment, but found no significant difference between the two groups. The third trial compared three corticosteroid regimens for severe type I reactions. After 12 months, a significantly higher proportion of individuals oil a 3 month course required extra corticosteroids compared to the groups with a high-dose and low-dose regimen of 5 months duration. Diabetes and peptic or infected ulcers were not significantly more often reported in the corticosteroid compared to the placebo group.Conclusion Evidence from RCTs does not show a significant long-term effect for either long-standing nerve function impairment or mild sensory impairment. A 5 month corticosteroid regimen was significantly more beneficial than a 3 month corticosteroid regimen. Further RCTs are needed to establish the effectiveness and optimal regimens of corticosteroids and to examine new therapies.",
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T2 - A Cochrane Review

AU - Van Veen, Natasja H. J.

AU - Nicholls, Peter G

AU - Smith, William Cairns Stewart

AU - Richardus, Jan Hendrik

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N2 - Objective Corticosteroids are commonly used for treating nerve damage ill leprosy. We assessed the effectiveness of corticosteroids for treating nerve damage due to leprosy.Methods A systematic search was undertaken to identify randomised controlled trials (RCTs) comparing corticosteroids with placebo or with no treatment. Two authors independently assessed quality and extracted data. Where it was not possible to perform a meta-analysis, the data for each trial was summarised.Results Three RCTs involving 513 people were found. Two trials compared prednisolone with placebo. One trial treated mild sensory impairment of less than 6 months duration and the other trial treated nerve function impairment of 6 to 24 months duration. Both trials examined nerve function improvement 12 months from the start of treatment, but found no significant difference between the two groups. The third trial compared three corticosteroid regimens for severe type I reactions. After 12 months, a significantly higher proportion of individuals oil a 3 month course required extra corticosteroids compared to the groups with a high-dose and low-dose regimen of 5 months duration. Diabetes and peptic or infected ulcers were not significantly more often reported in the corticosteroid compared to the placebo group.Conclusion Evidence from RCTs does not show a significant long-term effect for either long-standing nerve function impairment or mild sensory impairment. A 5 month corticosteroid regimen was significantly more beneficial than a 3 month corticosteroid regimen. Further RCTs are needed to establish the effectiveness and optimal regimens of corticosteroids and to examine new therapies.

AB - Objective Corticosteroids are commonly used for treating nerve damage ill leprosy. We assessed the effectiveness of corticosteroids for treating nerve damage due to leprosy.Methods A systematic search was undertaken to identify randomised controlled trials (RCTs) comparing corticosteroids with placebo or with no treatment. Two authors independently assessed quality and extracted data. Where it was not possible to perform a meta-analysis, the data for each trial was summarised.Results Three RCTs involving 513 people were found. Two trials compared prednisolone with placebo. One trial treated mild sensory impairment of less than 6 months duration and the other trial treated nerve function impairment of 6 to 24 months duration. Both trials examined nerve function improvement 12 months from the start of treatment, but found no significant difference between the two groups. The third trial compared three corticosteroid regimens for severe type I reactions. After 12 months, a significantly higher proportion of individuals oil a 3 month course required extra corticosteroids compared to the groups with a high-dose and low-dose regimen of 5 months duration. Diabetes and peptic or infected ulcers were not significantly more often reported in the corticosteroid compared to the placebo group.Conclusion Evidence from RCTs does not show a significant long-term effect for either long-standing nerve function impairment or mild sensory impairment. A 5 month corticosteroid regimen was significantly more beneficial than a 3 month corticosteroid regimen. Further RCTs are needed to establish the effectiveness and optimal regimens of corticosteroids and to examine new therapies.

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KW - function impairment

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KW - ulnar neuritis

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KW - management

KW - prednisolone

KW - prophylaxis

KW - prevention

M3 - Literature review

VL - 79

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JO - Leprosy Review

JF - Leprosy Review

SN - 0305-7518

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