Corticosteroids for treating nerve damage in leprosy.
BACKGROUND
Leprosy causes nerve damage which can result in nerve function impairment and disability. Corticosteroids are commonly used for treating nerve damage, although the long-term effect is uncertain.


OBJECTIVE
To assess the effects of corticosteroids on nerve damage in leprosy.


METHODS
We searched the Cochrane Neuromuscular Disease Group Register, the Cochrane Central Register of Controlled Trials (Issue 4), MEDLINE (from 1966), EMBASE (from 1980), CINAHL (from 1980), LILACS (from 1982) in January 2006. We checked reference lists of the studies identified, the Current Controlled Trials Register (www.controlled-trials.com), conference proceedings and contacted trial authors.


METHODS
Randomised and quasi-randomised controlled trials of corticosteroids for nerve damage in leprosy.


METHODS
The primary outcome was improvement in sensory and motor nerve function after one year. Secondary outcomes were improvement in nerve function after two years, change in nerve pain and tenderness, and adverse events. Two authors independently extracted data and assessed trial quality. We contacted trial authors for additional information. We collected adverse effects and cost effectiveness information from the trials and non-randomised studies.


RESULTS
We included three randomised controlled trials involving 513 people. Two trials compared prednisolone with placebo. One trial treated mild sensory impairment of less than six months duration and the other trial treated nerve function impairment of 6 to 24 months duration. Both trials examined an effect twelve months from the start of treatment. There was no significant difference in nerve function improvement between people treated with prednisolone or with placebo. The third trial compared three corticosteroid regimens for severe type 1 reactions. This trial did not report the prespecified outcomes. However, after 12 months, a significantly higher proportion of individuals on a 3-month course of prednisolone required extra corticosteroids compared to the groups with a high-dose and low-dose regimen of five months duration. Diabetes and peptic or infected ulcer were sometimes reported as serious adverse events in the placebo-controlled trials, but not significantly more often in the corticosteroid than placebo groups.


CONCLUSIONS
Corticosteroids are used for treating acute nerve damage in leprosy, but evidence from randomised controlled trials does not show a significant long-term effect. Randomised controlled trials are needed to establish their effectiveness, the optimal regimens and to examine new therapies.
Van Veen
N H J
NH
Erasmus MC, University Medical Center, Department of Public Health, PO Box 2040, Rotterdam, Netherlands, 3000 CA. n.vanveen@erasmusmc.nl
Nicholls
P G
PG
Smith
W C S
WC
Richardus
J H
JH
D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007918:Leprosy / Q000150:complications*; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D011239:Prednisolone / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D020886:Somatosensory Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology
D005938:Glucocorticoids; D011239:Prednisolone