Steroids for symptom control in infectious mononucleosis

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Abstract
Infectious mononucleosis (glandular fever) is associated with fatigue, fever, sore throat and swollen lymph nodes. The severity of symptoms can vary. In extreme cases, throat swelling can cause breathing difficulties and other complications requiring hospitalisation. The duration of symptoms is variable and can last for months. Few treatments are available and there are no universal criteria for using steroids in glandular fever. While steroids are generally reserved for severe complications, there are reports of practitioners treating symptomatic people with steroids. Infectious mononucleosis often affects young people at a time in their education where they need to be continually productive and the potential long duration of the condition is perhaps a key factor in prescribing such a potent drug for symptom control. To determine the efficacy and safety of steroids for symptom control in infectious mononucleosis. We searched CENTRAL (2011, Issue 1), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to February Week 3, 2011) and EMBASE (1974 to February 2011). Randomised controlled trials (RCTs) comparing the effectiveness of steroids with placebo or other interventions for symptom control for people with documented infectious mononucleosis. We independently assessed trial inclusion. Where appropriate, it was intended to combine trial results in a meta‐analysis. Seven trials were included. Heterogeneity between trials prevented combined analysis. Trials under‐reported methodological design features. Across the trials, no benefit was found in 8/10 assessments in health improvement. Two trials found at 12 hours benefit of steroid therapy over placebo in reducing sore throat (eight‐day course OR 21.00, 95% CI 1.94 to 227.20; one‐dose OR 4.20, 95% CI 1.08 to 16.32) but benefit was not maintained. In combination with an antiviral drug, another trial reported participants in the steroidal group had less pharyngeal discomfort between two to four days (OR 0.31, 95% CI 0.09 to 1.08). Across the trials effects on other common symptoms were less clear. Two trials set out to measure safety; they document no major adverse effects. In two other trials adverse events were reported, including respiratory distress and acute onset of diabetes. However, the association of the events with the steroid is not definite. There is insufficient evidence to recommend steroids for symptom control in infectious mononucleosis. There is a lack of research on the side effects, including potential adverse effects or long‐term complications. 類固醇對於傳染性單核白細胞增多症的症狀控制 腺熱﹝傳染性單核白細胞增多症﹞的症狀為疲倦、發燒、喉嚨痛以及淋巴腺腫大，症狀的輕重程度不一，喉嚨腫脹等併發症會造成呼吸困難，而病情複雜時必須住院治療, 症狀持續的時間長短也不一定，在某些病人甚至可以長達數個月。在治療方面，目前可用的方法不多，對於類固醇的使用，目前還沒有公認的準則。少數報告曾針對有症狀的病患使用類固醇，但一般而言通常只給予有嚴重併發症的病患。腺熱好發於在學中需要用功的年輕人身上，症狀可能持續的時間或許為是否使用類固醇這樣強效的藥物控制症狀與否的主要關鍵。 評判類固醇對於腺熱症狀控制的功效及安全性。 我們搜尋了考科藍臨床試驗註冊中心(CENTRAL)(考科藍文庫2005年第2期)、MEDLINE (1966年1月至2005年11月)、EMBASE (1974年1月至2005年11月)、以及英國國家研究註冊中心(2005年11月)。 必須是隨機對照試驗(RCTs)，內容為比較類固醇和安慰劑(或其他介入性治療)在症狀控制的效果，以登記患有腺熱的人為對像，年齡不限。 作者群獨立地依照事前所訂立的標準，評估試驗是否符合納入條件，各試驗的結果會依各項症狀分別獨立彙整，再作整合分析。 總共有7個臨床試驗納入分析。各研究的診斷、類固醇劑量、試驗結果、以及分析方法的品質都有差異，樣本數介於24到94之間。對於改善喉嚨痛，其中2個研究顯示治療12小時候，類固醇比安慰劑有效，但此效果無法持續。另外有1個研究顯示類固醇併用抗病毒藥物，有較長期的效益。另有1個研究發現類固醇或許可以減少持續疲勞的症狀約4週，但是否是因為併用抗病毒藥物則不清楚。其中有2個試驗中發現使用類固醇的病人出現嚴重的併發症。 目前關於此議題的證據不足  臨床試驗太少、缺乏一致性，而且其中某些品質不佳。因此，目前的研究不足以建議在腺熱的病人使用類固醇來控制症狀。對於副作用、併發症方面的研究也很缺乏，尤其是缺乏長期追蹤的資料。 本摘要由臺灣大學附設醫院許甯傑翻譯。 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。 類固醇對於傳染性單核白細胞增多症的症狀控制。腺熱﹝傳染性單核白細胞增多症﹞是唾液中帶原的感染，症狀為疲倦、發燒、喉嚨痛以及淋巴腺腫大。它好發於年輕成人，其嚴重度和病程長短有很大的差異，可能無症狀，也可能嚴重到有呼吸困難需要住院。症狀可以持續到數個月(它是慢性疲勞症候群的危險因子之ㄧ)。症狀治療和休息是常用的治療方式。本篇分析了4個比較類固醇和安慰劑的研究，以及3個使用類固醇加上其他藥物(抗病毒藥物或Aspirin)對於治療腺熱的效果。發現類固醇有短暫緩解喉嚨痛的效果(超過12小時)，但其效果在2至4天會消失。至於在其他症狀上的效果，無論單獨用類固醇或併用其他藥物，都缺乏足夠的證據。另外，使用類固醇會有潛在不良反應發生的機會。 Stéroïdes pour...