Meta-analysis: short-term steroids safe for kids with acute respiratory conditions

  • Fernandes RM & al.
  • BMJ Open
  • 1 Aug 2019

  • International Clinical Digest
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Takeaway

  • A meta-analysis of 85 studies finds no excess adverse events (AEs) associated with short-term use (up to 14 days) of corticosteroids in children

Why this matters

  • Results are reassuring, but questions still linger about growth suppression because of poor study quality.

Study design

  • Systematic review and meta-analysis of 85 studies (n=11,505 children), 68 of which were randomized trials, after a search of Medline, CENTRAL, Embase, and regulatory agencies.
  • Funding: Canadian Institutes of Health Research.

Key results

  • Oral dexamethasone (vs prednisone) is associated with fewer cases of vomiting (pooled OR [pOR], 0.29; 95% CI, 0.17-0.48; I2=0%; n=6 studies).
  • 5 studies reported on height:
    • 2 were pooled; they showed a small mean increase in height from baseline at 1 year favoring inhaled corticosteroids (vs placebo; mean difference [MD], 0.10 cm; 95% CI, −0.47 to 0.67 cm).
    • 1 of 3 nonpooled studies found a decrease in height z-score after 1 year with recurrent high-dose (1500 μg/day during infection) inhaled fluticasone for recurrent wheeze (vs placebo; adjusted MD, −0.24; 95% CI, −0.40 to −0.08).
  • AEs other than height: no significant differences in systemic or inhaled corticosteroids vs placebo, or between corticosteroids.

Limitations

  • Poor methodological quality of many studies resulting from lack of assessment and inadequate reporting of AEs.