For patients with Henoch Schönlein purpura, are corticosteroids an effective therapy to prevent renal damage?

Recent systematic reviews

1. Chartapisak W, Opastirakul S, Hodson EM, Willis NS, Craig JC. Interventions
for preventing and treating kidney disease in Henoch-Schönlein Purpura (HSP).
Cochrane Database Syst Rev. 2009 Jul 8;(3):CD005128.
Objective: To evaluate the benefits and harms of different agents compared with placebo or no treatment or another agent for the prevention or treatment of kidney disease in patients with HSP.

Literature review: RCTs and quasi-RCTs identified from the Cochrane Renal Group’s specialised register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE

Selection criteria: RCTs comparing any intervention used to prevent or treat kidney disease in HSP to placebo, no treatment or other agents

Quality assessment: Describes reproducible methods for assessing quality of and extracting data from studies.

Results: Identified 5 RCTs (N=789) of children with HSP randomized to prednisone or placebo and supportive care.  Table 4 shows no statistically significant difference between corticosteroids or placebo in preventing persistent kidney disease at any time after treatment.
2. Weiss PF, Feinstein JA, Luan X, Burnham JM, Feudtner C. Effects of corticosteroid on Henoch-Schönlein purpura: a systematic review. Pediatrics. 2007 Nov;120(5):1079-87.

Objective: Assess efficacy of corticosteroids in shortening duration of abdominal pain, decreasing odds of surgical intervention, and decreasing odds of HSP recurrence in patients with HSP.

Literature review: RCTs and observational studies identified from the Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE

Selection criteria: RCTs or observational studies comparing corticosteroids to placebo in treating HSP.

Quality assessment: Does include observational studies.  Does not describe quality of studies in detail but did conduct Egger tests for bias.

Results:  Two RCTs assessed resolution of abdominal pain (p. 1081) through 14-day symptom diaries.  In one, patients received 1 mg for 2 weeks, and favored corticosteroids (mean pain duration 1.2 days less).  The other RCT (patients received 2 mg for 1 week) found no significant difference in median pain duration.  Other outcomes are summarized on pages 1082-83.

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Clinical Informationist at EUH Branch Library
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