OBJECTIVE: To evaluate the efficacy differentials among corticosteroid regimens by type, dosage and duration, we conducted a systematic review and network meta-analysis of randomised controlled trials (RCTs).
METHODS: We searched four databases from their inception to March 2024 and included RCTs that evaluated oral corticosteroids for asthma exacerbations in young people aged <21 years. We compared six regimens (dexamethasone (DEXA) 0.3 mg/kg/day administered for 1 day, DEXA 0.6 mg/kg/day for 1 day, DEXA 0.6 mg/kg/day for 2 days, prednisolone (PSL) 1.0 mg/kg/day for 3 days, PSL 1.0-1.5 mg/kg/day for 5 days and PSL 2.0 mg/kg/day for 5 days). Primary outcome was relapse within 14 days, defined as unplanned visit to an emergency department or primary care physician.
RESULTS: Eleven studies involving 2353 patients were analysed in our quantitative synthesis. There were no significant differences in the relapse rates among 15 comparisons of six regimens. As part of the results, the network estimate showed that DEXA (0.3 mg/kg/day×1 day) compared with PSL (1.0 mg/kg/day for 3 days) had a risk ratio (RR) of 0.99 (95% CI 0.56 to 1.74), and DEXA (0.6 mg/kg/day for 2 days) compared with PSL (1.0-1.5 mg/kg/day×5 days) had an RR of 1.29 (95% CI 0.84 to 1.98). The certainty of the evidence for the included comparisons was low to very low.
CONCLUSION: In this network meta-analysis, there were no significant differences in the efficacy of commonly used corticosteroid regimens for acute exacerbations in childhood asthma. Short-term oral DEXA may be an acceptable alternative to a longer course of PSL.
PROSPERO REGISTRATION NUMBER: CRD 42023449189.
| Discipline Area | Score |
|---|---|
| Allergy and Immunology |  |
| Respirology/Pulmonology |  |
| Emergency Medicine | |
| Pediatric Emergency Medicine | |
| Family Medicine (FM)/General Practice (GP) | |
| Pediatrics (General) | |
Great paper and work by the team. Unfortunately, the certainty of the evidence was not reported in the main manuscript, which makes it difficult to interpret the findings unless one reviews the supplementary materials (which I doubt most clinicians will do).
A good time to give up the intramuscular administration route.
I would like to know that it is also equally 'safe.'
Emergency physicians frequently manage children presenting with asthma exacerbations. This systematic review evaluated the efficacy of various corticosteroids used for this purpose. However, it found no significant differences in the effectiveness of commonly used corticosteroid regimens for treating acute exacerbations. The certainty of the evidence was very low for most comparisons, largely due to serious concerns about imprecision. Well-designed and large-scale RCTs are needed to strengthen the evidence base and allow for more detailed comparisons between regimens.
Useful paper studying the various outpatient steroid regimens for mild-to-moderate paediatric asthma with findings supporting single lower-dose dexamethasone use as a reasonable alternative to a longer course of prednisolone.
