A Cochrane review included one non-blinded randomised controlled trial (RCT) with 35 eligible participants, the primary outcome for this review was not available. The trial had a high risk of bias. Twelve of 19 participants treated with prednisone, compared with five of 16 participants randomised to no treatment, had improved neuropathy impairment scores after 12 weeks; the risk ratio (RR) for improvement was 2.02 (95% confidence interval (CI) 0.90 to 4.52). Adverse events were not reported in detail, but one prednisone-treated participant died. In a double-blind RCT comparing daily standard-dose oral prednisolone with monthly high-dose oral dexamethasone in 40 participants, none of the outcomes for this review were available. The trial had a low risk of bias. There were no significant differences in remission (RR 1.11; 95% CI 0.50 to 2.45 in favour of monthly dexamethasone) or change in disability or impairment after one year. Eight of 16 in the prednisolone, and seven of 24 in the dexamethasone group deteriorated. Adverse events were similar with each regimen, except that sleeplessness and moon facies (moon-shaped appearance of the face) were significantly less common with monthly dexamethasone. Experience from large non-randomised studies suggests that corticosteroids are beneficial, but long-term use causes serious side effects.
In another double-blind RCT (n=40) comparing daily standard-dose oral prednisolone with monthly high-dose oral dexamethasone, none of the outcomes for this review were available. No comparator group was included, the trial compared two treatment groups. One group received 6 cycles of dexamethasone 40 mg daily for 4 days, followed by placebo for 24 days. The other group received prednisolone for 32 weeks, starting with 60 mg daily for 5 weeks and then gradually tapering to zero by the 32nd week.There were no significant differences in remission (RR 1.11; 95% CI 0.50 to 2.45) or change in disability or impairment after one year. In the prednisolone group 8/16, and in the dexamethasone group 7/24 deteriorated. Adverse events were similar with each regimen, except that sleeplessness and moon facies were significantly less common with monthly dexamethasone.Comment: The quality of evidence is downgraded by study quality (inadequate allocation concealment and blinding), imprecise results (limited study size for each comparison) and indirectness (other trial compared two treatment regimens).