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Treatment for neuralgic amyotrophy

Neuralgic amyotrophy is a painful disorder of the peripheral nervous system that occurs in episodes. It affects the arms and shoulders, and leads to muscle wasting and weakness. There has been anecdotal evidence that corticosteroids can have a favourable effect on pain and recovery. No randomised clinical trial could be found in either the original 2009 review or when searches were updated in 2011 to validate the effects of this type of treatment, or any treatment. One randomised controlled trial comparing prednisolone to placebo is currently awaiting formal reporting.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Corticosteroids for Guillain‐Barré syndrome

Guillain‐Barré syndrome is an uncommon paralysing illness, usually caused by autoimmune inflammation of nerves. In 25% of patients it leads to a requirement for artificial ventilation. About 5% of patients die and about 10% are left with persistent disability. Corticosteroid drugs (such as prednisolone) reduce inflammation and so should theoretically lessen nerve damage. We did not find any new trials in the update of this review but we had previously found eight trials with 653 participants. However, only six trials with 587 participants gave information about the primary outcome measure for this review, change in a seven‐point disability scale. When the results of these six trials were pooled there was no significant difference in this or any other outcome. This result was considered unreliable because of marked variations between the trials. In four small trials of oral corticosteroids, with 120 participants, in total there was significantly less improvement after four weeks with corticosteroids than without corticosteroids. In two large trials with a combined total of 467 participants, there was a trend towards more benefit from intravenous corticosteroids in improvement in disability after four weeks but this trend was not significant. Corticosteroids were not associated with a significant increase in harm except that diabetes was significantly more common. Unexpectedly, high blood pressure was much less common in the corticosteroid‐treated patients. The lack of more obvious benefit from corticosteroids is not understood but might be because the drugs have a harmful effect on muscles which counteracts the benefit from reducing inflammation in nerves.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Chemotherapy of second‐stage Human African trypanosomiasis

Human African trypanosomiasis (HAT), or sleeping sickness, is a painful and protracted disease transmitted through the bite of infected tsetse flies and it is found in rural parts of sub‐Saharan Africa. Sleeping sickness has two clinical phases but this review focuses only on treatment of the second‐stage, which is characterized by neurological changes and almost invariably fatal without treatment. There are only a few drugs currently available for second‐stage sleeping sickness, all with considerable adverse events and variable efficacy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Corticosteroids for HELLP syndrome in pregnancy

Pre‐eclampsia is a serious complication of pregnancy characterized by high blood pressure with protein in the urine and sometimes progression to seizures (fits). HELLP syndrome is a more severe form of pre‐eclampsia which can cause problems with liver function, blood clotting, and low platelets. HELLP may be diagnosed during pregnancy or after giving birth and is associated with ill health for the mother including liver hematoma, rupture, or failure; pulmonary edema; renal failure and death. Infant health may also be poor, primarily due to premature birth and growth restriction.This review examined the effect of treating women with HELLP syndrome using corticosteroids (which can reduce inflammation). The results of this review did not indicate that there was a clear effect on the health of pregnant women when treated with corticosteroids, or their babies. Corticosteroids did appear to improve some components of the women's blood tests, but it is not clear that this had an effect on their overall health. The review identified 11 randomized controlled trials involving 550 women that compared corticosteroid (dexamethasone, betamethasone, or prednisolone) given during pregnancy, just after delivery or in the postnatal period, or both before and after birth, with placebo or no treatment. Two further trials showed that there was no clear difference between dexamethasone and betamethasone on the substantive clinical outcomes for women or their infants. Dexamethasone did improve maternal platelet count and some biochemical measures to a greater extent than betamethasone.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Interventions for growth failure in childhood Crohn's disease

Growth failure occurs in 15‐40% of children with Crohn's disease. Growth in affected children is influenced by the disease process itself and by some treatments. Management in children differs from that in adults because of the required emphasis on achieving optimum growth and pubertal development. The aim of this review was to evaluate the effectiveness of various treatments for growth failure in childhood Crohn's disease. Three randomized controlled trials were identified. One trial did not show any benefit for linear growth with 6‐mercaptopurine treatment compared to placebo among children being treated with steroids. The other two trials looked at nutritional treatment (elemental feedings) versus steroids (prednisolone). Both trials showed a statistically significant benefit for height velocity standard deviation scores with nutritional treatment. However, these results need to be confirmed by large, multi‐centre, randomized controlled trials of therapeutic interventions in pre‐pubertal children with Crohn's disease. These trials should use growth as an outcome measure. In conclusion, more research is needed to identify effective treatments for growth failure in childhood Crohn's disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Treatments for strawberry birthmarks of the skin in infants and children

Infantile haemangiomas are soft, raised swellings on the skin, often with a bright, red surface. They are a non‐cancerous overgrowth of blood vessels in the skin. They are commonly known as 'strawberry birthmarks', 'strawberry naevi', or 'capillary haemangiomas'. They occur in five per cent of babies, with the majority appearing within the first few weeks of life, and reach their full size at about three to six months of age. The vast majority are uncomplicated and will shrink on their own by five to seven years of age and require no further treatment. However, some infantile haemangiomas may occur in high‐risk areas (such as near the eyes and nose which can result in impairment to vision and airway obstruction, respectively) and some of them are disfiguring and psychologically distressing to the children and their parents. Some may also develop complications so early medical treatment may be necessary. Corticosteroids are currently the standard treatment; however, it is not known which of a variety of treatments is best.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Treatments for bullous pemphigoid

Bullous pemphigoid (BP) is the most common autoimmune blistering disease in the West. Incidence figures are not available for most parts of the world but BP appears to be rarer in the Far East. Bullous pemphigoid is usually a disease of the elderly but it can also affect younger people and children. Both sexes are similarly affected. While BP usually resolves within five years, there is a moderate death rate associated with the disease and its treatment. Oral corticosteroid drugs are the most common treatment, but may be associated with serious adverse effects, including some deaths. The most common adverse effects of oral steroids, include weight gain and high blood pressure. Long‐term use is associated with an increased risk of diabetes mellitus and decreased bone density. Topical steroids are also associated with adverse effects, such as thinning of the skin and easy bruising. The risk of experiencing adverse effects of topical steroids depends on the strength of the steroid, how long it is used for, which area of the body it is applied to, and the kind of skin problem; if a high‐strength, potent steroid is used, enough may be absorbed through the skin to cause adverse effects in the rest of the body.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Intravenous immunoglobulin for people with chronic inflammatory demyelinating polyradiculoneuropathy

We performed this review to assess the evidence from randomised trials on how effective and safe intravenous immunoglobulin (IVIg) is for people with CIDP.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Corticosteroids for treating cerebral malaria

Cerebral malaria is a severe form of the disease that can induce convulsions and coma; about 15% to 50% of patients with cerebral malaria will die, and 5% to 10% of survivors are left disabled as a result of brain damage.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Corticosteroid regimens for treatment of acute and chronic graft versus host disease (GvHD) after allogenic stem cell transplantation

Corticosteroids are commonly used to treat acute and chronic graft‐versus‐host disease (GvHD) but their effect on length and quality of life of patients has not been studied systematically. In this systematic review, we tried to compare the effect of treatment regimens used for GvHD in the absence and presence of corticosteroids, or with different doses of corticosteroids. After searching relevant sources, we located only two studies that met our criteria to be included in the study. Their results are described in detail in the text of the review. In brief, these studies are in favor earlier remission and slightly better outcome in patients but more evidence is needed in this field.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

No evidence to support or refute glucocorticosteroids for patients with primary biliary cirrhosis

Primary biliary cirrhosis is a chronic progressive cholestatic liver disease of presumed autoimmune aetiology. The clinical course might be improved by glucocorticosteroids. Only two small randomised clinical trials on this topic were identified. The trials were not large enough in terms of sample size or length of follow up to allow changes in mortality to be adequately evaluated. Glucocorticosteroids were associated with improvement in serum markers of inflammation and liver histology, both of which were of uncertain clinical significance. Glucocorticosteroids were also associated with adverse events, including reduced bone mineral density. Further trials are necessary if the effectiveness of glucocorticosteroids is to be properly evaluated.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Glucocorticoids for croup

Croup is common in children and is thought to be triggered after a viral infection. Croup causes swelling in the throat and windpipe (trachea) and causes hoarseness, a barking cough and noisy breathing. Croup usually gets better by itself but sometimes drugs are used to try and improve this condition. The review looked at trials of one type of steroid drug, glucocorticoids. Glucocorticoids can reduce the swelling and make it easier for the child to breathe. We found that glucocorticoids can start improving croup in children within six hours (14 studies, 1031 children). The effect lasts about 12 hours (eight studies, 532 children), lessens the need for other drugs, and shortens hospital stays by 12 hours (eight studies, 795 children). There were no adverse events associated with glucocorticoids. Additional studies are needed to determine the best dose of glucocorticoids.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Interventions for untreated patients with AIDS‐associated non‐Hodgkin's lymphoma

Lymphoma is a cancer of the lymphatic system. There are two general types: Hodgkin's disease (HD) and non‐Hodgkin's lymphoma (NHL). Non‐Hodgkin's lymphoma is the most common AIDS‐defining malignancy in HIV‐infected patients. The most frequent clinical presentations of NHL during AIDS are systemic illness with the compromise of the primary central nervous system and with primary effusion. In people with HIV infection, most lymphomas have originated in an aggressive B‐cell precursor and have a high‐to‐intermediate histology grade. Randomised controlled trials (RCTs) of different interventions for treating AIDS‐associated NHL found unclear evidence for efficacy and safety.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis)

Idiopathic acute vestibular dysfunction (vestibular neuritis) is a common condition of unknown cause. Patients with the condition often experience dizziness, nausea or vomiting, and trouble with vision, balance or mobility, but have normal hearing and no tinnitus. It has been proposed that a course of corticosteroids, if given early on, may improve recovery from the condition and long‐term patient outcome. However, corticosteroids can cause adverse effects (e.g. bleeding stomach ulcer, mood changes, etc.).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Orbital therapy for adult thyroid eye disease

Thyroid eye disease is a condition that is still not fully understood but results in inflammation of the eye and the tissues around the eye. It can cause changes in appearance (such as puffiness and redness of eyelids and conjunctiva, 'starey' eyes and misaligned eyes), discomfort, double vision and decreased vision. Orbital radiotherapy is a treatment given to reduce the inflammation and its associated changes. It is given in an outpatient setting and as the dose is divided into smaller daily doses it often involves up to 12 visits. This review included five randomised controlled trials involving 244 participants. A combined analysis of trials using our primary outcome showed that the 'risk' of success in a patient who received radiotherapy was 1.92 times that of a patient who did not receive radiotherapy. Single studies suggested that orbital radiotherapy in combination with steroids had a better outcome than steroids alone. There was no significant change in quality‐of‐life information collected in the orbital radiotherapy groups compared to the other groups. The short‐term adverse events reported in the trials were mild and localised to the area of treatment (redness of skin and temporal hair loss). However, trial methodology may have led to a decreased rate of adverse events from radiotherapy. Three trials excluded diabetic patients and these patients have been reported, in the literature, to be at higher risk of developing radiation retinopathy and of having progression of pre‐existing diabetic retinopathy. Some studies did not report on retinal changes at all.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Corticosteroids for chronic inflammatory demyelinating polyradiculoneuropathy

We reviewed the evidence about the benefits and harms of using corticosteroids for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Type I interferons for treatment of active ulcerative colitis

Ulcerative colitis (UC) is a long‐term (chronic) inflammatory bowel disease characterized by abdominal pain, bloody diarrhea, and a need to hurry to the toilet to pass feces (fecal urgency).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Are shorter courses of systemic steroids as effective as conventional longer courses in the treatment of patients with flare‐ups of COPD?

Chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis, is a long‐term lung condition that is commonly associated with smoking. Patients with COPD may experience flare‐ups (exacerbations), often precipitated by infection, in which symptoms such as breathlessness, cough and phlegm become markedly worse, and extra treatment or admission to hospital is required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Antiviral treatment for Bell's palsy

We reviewed the evidence about the effect of antiviral therapy alone or in combination with any other therapy, on Bell's palsy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Prednisolone and budesonide for short- and long-term treatment of microscopic colitis: systematic review and meta-analysis

BACKGROUND & AIMS: The incidence of microscopic colitis and its disease burden are increasing, yet there is limited systematic information addressing the use of conventional corticosteroids and budesonide in microscopic colitis. We performed a systematic review and meta-analysis on the short- and long-term efficacy of corticosteroids in treatment of microscopic colitis.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Systematic Reviews in PubMed

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