A Cochrane review [Abstract] 1 included 8 trials with a total of 653 subjects. Four studies (n=120) used the equivalent of oral prednisolone 40 mg daily for at least 2 weeks. One trial (n=10) compared iv. methylprednisolone (MP) 1500 mg daily for 5 days with no treatment and another (n=242) compared iv. MP 500 mg daily for 5 days with placebo. One trial (n=225) used IvIg 0.4 g/kg daily for 5 days with MP 500 mg daily for 5 days or placebo. The disability grade change after 4 weeks with corticosteroids was not significantly different from the control group (MD 0.36, 95% CI 0.16 more to 0.88 less improvement; 6 studies, n=587). In 4 oral corticosteroid trials there was less improvement after 4 weeks with corticosteroids than without (MD 0.82, 95% CI 0.17 to 1.47 grades less). In 2 trials (n= 467) there was no significant difference of a disability grade improvement after 4 weeks with iv. corticosteroids (MD 0.17, 95% CI -0.06 to 0.39). There was also no significant difference between corticosteroids and control groups for improvement by one or more grades after 4 weeks (RR 1.08, 95% CI 0.93 to 1.24; 5 studies, n=567) or for death or disability after one year (RR 1.51, 95% CI 0.91 to 2.5; 3 studies, n=491). The occurrence of diabetes was more common (RR 2.21, 95% CI 1.19 to 4.12; 2 studies, n=467) and hypertension less common (RR 0.15, 95% CI 0.05 to 0.41; 2 studies, n=467) in the corticosteroid-treated participants.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity of results).
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