Ciclesonide versus placebo for chronic asthma in adults and children

Manning, Pat; Gibson, Peter G.; Lasserson, Toby J

doi:10.1002/14651858.cd006217.pub2

Cited by 15 publications

(13 citation statements)

References 76 publications

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“…Thirty-five reviews, including 179 trials with adult and 117 with pediatric participants, were finally analyzed (15, (Supplementary Table S1 online). From these reviews, 19 assessed the risk of bias (18,20,22,25,26,28,29,32,35,(37)(38)(39)(40)(41)44,46,(49)(50)(51), 6 reported only the Jadad score (15,19,21,36,45,48), 4 assessed only the allocation concealment (34,42,43,47), and 6 did not assess quality (23,24,27,30,31,33). Overall, 13 382 adult and 5 417 pediatric participants were enrolled in the placebo groups.…”

Section: Resultsmentioning

confidence: 99%

Is the perceived placebo effect comparable between adults and children? A meta-regression analysis

et al. 2016

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Background: A potential larger perceived placebo effect in children compared with adults could influence the detection of the treatment effect and the extrapolation of the treatment benefit from adults to children. This study aims to explore this potential difference, using a meta-epidemiological approach. Methods: A systematic review of the literature was done to identify trials included in meta-analyses evaluating a drug intervention with separate data for adults and children. The standardized mean change and the proportion of responders (binary outcomes) were used to calculate the perceived placebo effect. A meta-regression analysis was conducted to test for the difference between adults and children of the perceived placebo effect. results: For binary outcomes, the perceived placebo effect was significantly more favorable in children compared with adults (β = 0.13; P = 0.001). Parallel group trials (β = −1.83; P < 0.001), subjective outcomes (β = −0.76; P < 0.001), and the disease type significantly influenced the perceived placebo effect. conclusion: The perceived placebo effect is different between adults and children for binary outcomes. This difference seems to be influenced by the design, the disease, and outcomes. Calibration of new studies for children should consider cautiously the placebo effect in children.

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Section: Resultsmentioning

confidence: 99%

Is the perceived placebo effect comparable between adults and children? A meta-regression analysis

et al. 2016

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“…In seven metaanalyses, ORs observed in pediatric trials were quite close to those observed in adults with an upper margin of the CI close to 1 [23,42,63,70,82,87,101] [63]. The lack of power due to the number of included children could explain the inconclusive ORs.…”

Section: Discussionmentioning

confidence: 77%

“…Eighty-nine meta-analyses including 992 RCTs, 294 in children and 698 in adults, were eligible for our study [16e104]. Out of the 89 meta-analyses included, 21 gave no report of the Jadad score or of the risk of bias [25,26,28,38,43e46,49,55e58, 74,78,81,84,86,91,96,103]; 12 reported only the Jadad score for each RCTs [23,42,82,88,90,98,100] or an overall score [64,68,75,85,99]; 10 reported the Jadad score and the risk of bias [17,19,31,37,67,70,77,95,101,104]; 31 reported a full assessment of the risk of bias [18,20,21,24, 27,29,30,32,34e36,39,47,48,53,54,59e61,65,69,71e73,76, 79,87,92e94,102]; and 15 only gave the risk of bias for allocation concealment [16,22,33,40,41,50e52,62,63,66, 80,83,89,97].…”

Section: Resultsmentioning

confidence: 99%

Different treatment benefits were estimated by clinical trials performed in adults compared with those performed in children

Janiaud

Lajoinie

Cour-Andlauer

et al. 2015

Journal of Clinical Epidemiology

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“…Similar findings of improved asthma outcomes have been found in other retrospective database studies in adults with poorly controlled asthma treated with large particle ICS compared to small particle ICS monotherapy(115, 116). Conversely, meta-analyses of randomized controlled trials have not found differences in asthma outcomes between small and larger particle ICS(117–119). Finally, a crossover comparison of small-particle and larger particle ICS in children 6–12 years showing no additional benefit for treatment with small particle ICS in measures of small airways inflammation(120).…”

Section: Managementmentioning

confidence: 99%

Severe Asthma in Children

Guilbert

Bacharier

Fitzpatrick

2014

The Journal of Allergy and Clinical Immunology: In Practice

158

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Severe asthma in children is characterized by sustained symptoms despite treatment with high doses of ICS or oral corticosteroids. Children with severe asthma may fall into two categories, difficult-to-treat asthma or severe therapy-resistant asthma. Difficult-to-treat asthma is defined as poor control due to an incorrect diagnosis or comorbidities, poor adherence due to adverse psychological or environmental factors. In contrast, treatment-resistant is defined as difficult asthma despite management of these factors. It is increasingly recognized that severe asthma is a highly heterogeneous disorder associated with a number of clinical and inflammatory phenotypes that have been described in children with severe asthma. Guideline based drug therapy of severe childhood asthma is based primarily on extrapolated data from adult studies. The recommendation is that children with severe asthma be treated with higher-dose inhaled or oral corticosteroids combined with long-acting beta-agonists and other add on therapies such as antileukotrienes and methylxanthines. It is important to identify and address the influences that make asthma difficult to control including reviewing the diagnosis and the removal of causal or aggravating factors. Better definition of the phenotypes and better targeting of therapy based upon individual patient phenotypes is likely to improve asthma treatment in the future.

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Ciclesonide versus placebo for chronic asthma in adults and children

Cited by 15 publications

References 76 publications

Is the perceived placebo effect comparable between adults and children? A meta-regression analysis

Is the perceived placebo effect comparable between adults and children? A meta-regression analysis

Different treatment benefits were estimated by clinical trials performed in adults compared with those performed in children

Severe Asthma in Children

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