Oral systemic corticosteroids in children with acute asthma exacerbations: a systematic review and network meta-analysis

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Vydáno v:	Archives of Disease in Childhood (Jun 2025), p. archdischild-2024-327523
Hlavní autor:	Amagasa, Shunsuke
Další autoři:	Utsumi, Shu, Okajima, Kie, Uematsu, Satoko
Vydáno:	BMJ Publishing Group LTD
Témata:	Prednisolone Clinical trials Emergency medical care Intervention Asthma Web portals Dexamethasone Pediatrics Drug dosages Corticosteroids Dual energy X-ray absorptiometry Corticoids Sensitivity analysis Children Comparative studies Steroids Meta-analysis Primary care Systematic review Physicians Clinical outcomes Social Patients Meta Analysis Evidence Computer Oriented Programs Search Strategies Medical Services Information Seeking Computer Software Reviews Statistical Analysis Comparative Analysis Protocol Materials Networks
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Popis
Abstrakt:	ObjectiveTo 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).MethodsWe 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.ResultsEleven 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.ConclusionIn 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 numberCRD 42023449189.
ISSN:	0003-9888 1468-2044
DOI:	10.1136/archdischild-2024-327523
Zdroj:	Science Database