Re: Corticosteroids for sore throat: a clinical practice guideline
I remain stunned that the JAMA paper by Hayward and colleagues was considered "positive" and was the impetus for this updated, rapid review.
This was a negative study. The primary outcome, complete resolution at 24 hours, was negative. Only 1 -- complete resolution at 48 hours -- of about 8 secondary outcomes was positive. This was probably due to the play of chance. There was no difference in the time to resolution of symptoms between the steroid and placebo groups. "There were no significant differences between groups in the use of pain relief medications (topical and oral), antibiotics for sore throat, or antibiotics for other conditions and no differences in the proportion of participants missing any time away from work or education."
Even if the benefit at 48 hours were "real" -- and I am not allowing that it is because all of the other outcomes are negative -- in absolute terms, at 48 hours, only 35% of patients were better compared to 27% in the placebo group, a very small difference with a NNT of 13.
Again, this was a negative study and should not be included in this meta-analysis.
Hayward GN, Hay AD, Moore MV, Jawad S, Williams N, Voysey M, Cook J, Allen J, Thompson M, Little P, Perera R, Wolstenholme J, Harman K, Heneghan C. Effect of Oral Dexamethasone Without Immediate Antibiotics vs Placebo on Acute Sore Throat in AdultsA Randomized Clinical Trial. JAMA. 2017;317(15):1535–1543. doi:10.1001/jama.2017.3417
Competing interests: No competing interests