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Prostate cancer is the most common male cancer, excluding non-melanoma skin cancer, in the UK, accounting for around 13% of male cancer deaths. In 2001, there were 26,027 new cases in England and 1746 in Wales, giving age-standardised incidence rates of 89.8 and 92.6 per 100,000 men, respectively. The majority of patients are diagnosed with early disease and have a good prognosis. However, approximately 22% of cases will be diagnosed with advanced or metastatic disease, with an additional 25% developing metastases throughout the course of the disease. The majority of prostate cancers initially respond to hormone therapy, with a median response duration in metastatic disease of around 18 months. However, in most patients the cancer will become resistant to hormonal treatment and will progress. After developing hormone-resistant disease, survival is not expected to exceed 9-12 months. Treatment for metastatic hormone-refractory prostate cancer (mHRPC) is palliative and current advice issued by the National Institute for Health and Clinical Excellence states that chemotherapy should be considered and trials of chemotherapy supported, and palliative radiotherapy should also be considered as a treatment option. The use of chemotherapy for mHRPC is widespread in the UK. New trials assessing the effectiveness for the treatment of mHRPC of docetaxel, which is licensed for use in combination with prednisone/prednisolone in the UK, have emerged. The cost of a course of up to 10 cycles of docetaxel at the recommended dose is approximately £11,000. Therefore the evidence must be appraised by a systematic review and economic model.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2007

To conduct a meta-analysis of published data of the effectiveness of drug treatment in giant cell arteritis (GCA) to provide evidence to support the optimal use of glucocorticoids (GCs) and adjunct therapy. MEDLINE, CENTRAL and EMBASE searches were used to identify randomised control trials on the treatment of GCA. Studies included were trials in which: (1) the participants were classified as having GCA by the 1990 ACR criteria or biopsy proven disease; (2) parallel-group randomised control of at least 16 weeks duration had been conducted with at least 20 participants; (3) the design included either alternative adjunct immunosuppressant regimens, alternative GCs dosing or routes of administration; and (4) outcome data was included on either relapse rates or rates of infection. One thousand eight hundred thirty-six articles were retrieved, of which only 37 met the primary inclusion criteria. Sixteen of these studies reported some information about the GCs or adjuvant regimen used. Only ten studies were of sufficient quality to be included in the meta-analysis. Together these comprised 638 participants of which 72 % were female. Three studies compared various GCs regimens, with two comparing IV GCs, the latter showing a marginal benefit with respect to relapse (risk ratio (RR) = 0.78, 95 % CI = 0.54 to 1.12) but a greater risk of infection (RR = 1.58, 95 % CI = 0.90 to 2.78). Another three used methotrexate as an adjunctive agent and showed marginal benefit with respect to relapse (RR = 0.85, 95 % CI = 0.66 to 1.11). The remaining four trials compared prednisolone to dapsone, infliximab, adalimumab and hydroxychloroquine, respectively. There are various clinical trials of varying quality. The results from this meta-analysis show that the use of adjunct agents is not associated with improved outcome.

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

Version: 2014

Inhaled corticosteroids form the first choice for preventative treatment of asthma, but they remain expensive for health economies in developing countries. Oral prednisolone is very much cheaper. In this review, we found that, in the management of adults with chronic asthma, a daily dose of prednisolone 7.5 mg/day appears to be equivalent to a moderate to high dose of inhaled steroids (300‐2000 mcg/day). Side effects may be present even with low doses of prednisolone, so if there is no alternative to oral steroids, the lowest effective dose should be prescribed. These findings may be use in developing countries where inhaled steroids are not widely available.

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

Version: January 22, 2001

Corticosteroid drugs can relieve inflammation, and in high doses they have a dramatic effect on the symptoms of rheumatoid arthritis. They are used only temporarily, however, because of serious adverse effects during long‐term use. The review found that corticosteroids in low doses are very effective. They are more effective than usual anti‐arthritis medications (non‐steroidal anti‐inflammatory drugs, or NSAIDs). The risk of harms needs to be considered, however, especially the risk of fractures and infections.

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

Version: January 24, 2005

Leprosy is a chronic infectious disease. Leprosy bacteria cause damage to skin and peripheral nerves which may result in nerve function impairment and disability. Decompressive surgery is used for treating nerve damage although its effect is uncertain. Two randomised controlled trials (RCTs) were included in the review and examined the added benefit of surgery over prednisolone for treatment of nerve damage of less than six months duration. Both trials were at high risk of bias. Two years from the start there was very low quality evidence of no significant difference in nerve function improvement between people treated with surgery plus prednisolone or with prednisolone alone. Adverse effects of decompressive surgery were not adequately described. No additional trials were identified when searches were updated in 2010 and 2012. Decompressive surgery is used for treating nerve damage in leprosy but the available evidence from RCTs is of very low quality and does not show a significant added benefit of surgery over steroid treatment alone. Well‐designed RCTs are needed to establish the effectiveness of the combination of surgery and medical treatment compared to medical treatment alone.

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

Version: December 12, 2012

Leprosy is a long‐term infectious disease. Leprosy bacteria cause damage to the skin and peripheral nerves (nerves outside the brain and spinal cord). This damage can stop nerves from working normally and cause disability. Corticosteroids, especially prednisolone, are often used to treat nerve damage in leprosy, but their long‐term effect is uncertain.

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

Version: May 23, 2016

The optimum treatment for infantile spasms has yet to be proven with confidence, in part because of the different aims of existing studies. However, some useful conclusions can be drawn from current evidence.

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

Version: June 5, 2013

Leprosy remains a public health issue in poorer parts of the world. In 2007 there were approximately 255,000 new cases reported worldwide. Leprosy (or Hansen's disease) is a chronic infectious disease. The skin and peripheral nerves of people with leprosy contain leprosy bacteria. Leprosy can be cured with a combination of antibiotics. The immune system plays an important role in leprosy and determines if and how the disease will develop. The response of the immune system to the antigens of the leprosy bacteria may cause periods of inflammation in the skin and nerves, called reactions. Reactions are the main cause of acute nerve damage and disability in leprosy and occur in about one third of people with leprosy. One type of reaction is erythema nodosum leprosum (ENL), a serious and often chronic complication of leprosy caused by the immune system. People with ENL have red, painful swellings in the skin and often feel ill due to fever and general malaise. There are several treatments for ENL, including the oral drugs prednisolone, thalidomide, and clofazimine. We undertook a systematic review on this topic as it was not clear which treatments were most beneficial.

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

Version: July 8, 2009

Wegener's granulomatosis is a rare disorder that causes inflammation of the blood vessels. This inflammation restricts blood flow to various organs which can eventually damage the organs. Organs most affected by Wegener's include the lungs, upper respiratory tract, kidneys, joints, skin and eyes. Wegener's granulomatosis also produces a granuloma (a mass or nodule of inflammatory tissue) which is found around the blood vessels and which can also damage surrounding tissue. The cause of Wegener's granulomatosis is unknown. Treatment is with corticosteroids and cytotoxic drugs which are often used for chemotherapy. Most patients get better with these drugs. However, the disorder returns in approximately half of patients. Intravenous immunoglobulin (IVIg) is an expensive and fairly rare blood product that has been used to treat Wegener's granulomatosis but its effects on the disorder are unknown. We asked if IVIg provided an advantage as an additive to standard treatments. We found one small randomized trial in which 34 participants were randomized to receive IVIg or placebo once daily in addition to azathioprine and prednisolone for remission maintenance. This trial did not provide enough evidence to determine if IVIg has an advantage over corticosteroids and immunosuppressants for the treatment of Wegener's granulomatosis.

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

Version: January 31, 2013

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: July 8, 2009

Idiopathic sudden sensorineural hearing loss (ISSHL) is sudden loss of hearing where clinical assessment has failed to reveal a cause. Patients may also suffer from additional symptoms such as tinnitus (a background ringing noise), together with dizziness and a sensation of fullness in the ear. Prompt investigation is essential to identify and treat the hearing impairment. In a large proportion of patients, however, no cause can be found.

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

Version: August 15, 2012

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: June 28, 2013

In recurrent corneal erosion repeated episodes of breakdown of the corneal surface produce disabling eye symptoms and predispose the cornea (the transparent part at the front of the eye) to infection. Recurrent corneal erosions may happen after trauma to the cornea. Management may be required to prevent the recurrence of the erosions following corneal trauma or once the diagnosis is made, or both. Most episodes of recurrent corneal erosion resolve with simple medical therapy such as topical eye drops and ointment. When such simple measures fail or recurrences become too frequent, alternative treatment strategies are required. This review included seven trials with a total of 443 participants. The trials were conducted in Germany, People's Republic of China, Japan, Sweden and three in the UK. The quality of the trials was poor and the authors found the level of evidence insufficient for the development of management guidelines. There was limited evidence that oral tetracycline or topical prednisolone, or both, and excimer laser ablation, may be effective treatments for recurrent corneal erosion. More good‐quality randomised controlled trials are needed to guide the management of recurrent corneal erosion.

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

Version: September 12, 2012

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: October 6, 2010

Bell's palsy is a paralysis or weakness of muscles in the face, usually on one side, with no certain cause. Symptoms usually recover, although not always. Reducing inflammation of the facial nerve using corticosteroid medicines (steroids) is thought to limit nerve damage. This is an update of a review first published in 2002 and last updated in 2010.

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

Version: July 18, 2016

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: July 26, 1999

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: April 20, 2005

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: January 19, 2011

Ulcerative colitis is a chronic relapsing inflammatory disorder of the large bowel. Although corticosteroids are effective for treating ulcerative colitis, approximately 20% of patients who respond become sick again when steroids are withdrawn and become steroid dependent. Furthermore, corticosteroids exhibit significant adverse effects. Tumour necrosis factor alpha (TNF‐α) is a proinflammatory cykotine that is involved in the pathogenesis of rheumatoid arthritis, Crohn's disease and psoriasis. TNF‐ α blocking drugs may provide an alternative treatment for patients who do not respond to corticosteroid and/or immunosuppressive drug treatment. This review shows that intravenous infusions of infliximab, a TNF‐α blocking agent is effective in inducing clinical remission, promoting mucosal healing, and reducing the need for colectomy in patients with active ulcerative colitis whose disease has not responded to conventional treatment.

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

Version: July 19, 2006

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: September 14, 2015

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