Comparative Effectiveness of Dexamethasone versus Prednisone in Children Hospitalized with Asthma

Parikh, Kavita; Hall, Matt; Mittal, Vineeta; Montalbano, Amanda; Gold, Jessica; Mahant, Sanjay; Wilson, Karen M.; Shah, Samir S.

doi:10.1016/j.jpeds.2015.06.038

Cited by 38 publications

(46 citation statements)

References 18 publications

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“…The third study compared the effectiveness of prednisone versus dexamethasone in more than 40,000 children hospitalized with asthma exacerbation not requiring intensive care. 39 Dexamethasone treatment was associated with a shorter length of stay and a lower cost index; however, there was no difference in intensive care unit transfer or readmission. Two infectious disease-related studies were identified.…”

Section: Examples Of Observational Studies Evaluating Drug Efficacy Amentioning

confidence: 89%

“…The study found that children treated with montelukast were more than 2 times as likely to experience treatment failure and be admitted to the hospital, and incurred greater asthma‐treatment related costs. The third study compared the effectiveness of prednisone versus dexamethasone in more than 40,000 children hospitalized with asthma exacerbation not requiring intensive care . Dexamethasone treatment was associated with a shorter length of stay and a lower cost index; however, there was no difference in intensive care unit transfer or readmission.…”

Section: Examples Of Observational Studies Evaluating Drug Efficacy Amentioning

confidence: 99%

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Identifying the “Blip on the Radar Screen”: Leveraging Big Data in Defining Drug Safety and Efficacy in Pediatric Practice

Christensen

Davis

2018

The Journal of Clinical Pharma

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The immense amount of electronic health data (pharmacy and administrative claims, electronic health records, and clinical registries) that is being generated every day in the care of patients has the potential to be leveraged for improving clinical decisions at the point of care, uncovering or validating drug efficacy and drug safety. The potential use of big data for improving safe and effective use of medications is especially important in children because of their low drug exposure relative to adults. Electronic health data is collected primarily for clinical or billing purposes and not for research purposes. The major steps involved in data acquisition, extraction, aggregation, analysis, modeling, and interpretation are discussed. It is important to understand the limitation of big data and utilize appropriate study design and statistical methods. Possible applications are presented along with specific examples of how big data has been used in drug research to find that blip on the radar screen that may give an efficacy or safety signal that can lead to further investigation.

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Section: Examples Of Observational Studies Evaluating Drug Efficacy Amentioning

confidence: 89%

Section: Examples Of Observational Studies Evaluating Drug Efficacy Amentioning

confidence: 99%

Identifying the “Blip on the Radar Screen”: Leveraging Big Data in Defining Drug Safety and Efficacy in Pediatric Practice

Christensen

Davis

2018

The Journal of Clinical Pharma

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“…Several of the studies reviewed in this article showed better compliance and less vomiting with oral dexamethasone compared with prednisolone. Dexamethasone is cheaper than soluble prednisolone tablets (see table 2 for cost), and Parikh et al ’s5 cohort study found a significant difference in length of stay (>3 days) for those children admitted with wheeze who were given prednisolone (12%) versus those children given dexamethasone (6.7%, p=0.002).…”

Section: Search Strategymentioning

confidence: 99%

Is oral dexamethasone as good as oral prednisolone for childhood wheeze requiring steroids?

Steensma

Bird

2018

Arch Dis Child

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“…They found no significant difference between groups for the outcomes of allcause 7 and 30-day readmissions and for transfers to the ICU. 17 Although the findings of this study reveal that dexamethasone may be an alternative to prednisone for inpatients, all subjects with an All-Patient Refined Diagnosis-Related Group (APR-DRG) of moderate, major, or extreme were excluded in the study. In the previously discussed ED studies, [8][9][10]12,14 the patients with the highest exacerbation severity (ie, those admitted to the hospital from the ED) were also largely excluded; therefore, it is important to understand outcomes for this population.…”

mentioning

confidence: 91%

“…16 To our knowledge, there is only 1 study in which the authors examine the comparative effectiveness of dexamethasone versus prednisone for inpatients. In the multicenter retrospective cohort study, after employing propensity score matching within hospital, Parikh et al 17 found that the proportion of subjects with a length of stay (LOS) of $3 days was significantly smaller in the dexamethasone group compared with that in the prednisone group. In addition, they found that the dexamethasone group had a significantly lower index admission cost.…”

mentioning

confidence: 99%

Outcomes for Pediatric Asthmatic Inpatients After Implementation of an Emergency Department Dexamethasone Treatment Protocol

Tyler

Cotter

Moss

et al. 2019

Hospital Pediatrics

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Evidence supports using dexamethasone for mild-to-moderate asthma exacerbations in the emergency department, but the effectiveness of dexamethasone versus prednisone for asthmatic patients who are hospitalized is unclear. Our aim was to compare outcomes for inpatients before and after our emergency department's adoption of dexamethasone for the treatment of acute asthma exacerbations. METHODS: In this single-center retrospective cohort study, we employed interrupted time series analyses to control for secular trends while evaluating our outcomes of length of stay, total inflation-adjusted hospital charges, and ICU transfer rates for patients admitted with asthma. RESULTS: Data were analyzed over 36 months (January 2014-April 2017) and included 1015 subjects (606 in the preprotocol change [pre-PC] group and 409 in the postprotocol change [post-PC] group). In the pre-PC group, prednisone only was used in 96% of subjects. In the post-PC group, prednisone only was used in 7% of subjects, dexamethasone in 65% of subjects, and a combination of the 2 steroids in 28% of subjects. Controlling for other variables in the interrupted time series model, we found no significant immediate differences between the pre-PC and post-PC periods for the outcomes of length of stay (P 5 .68), total charges (P 5 .66), and ICU transfers (P 5 .98). The rate of ICU transfers was stable pre-PC and increased by 10% (95% confidence interval: 2%-19%) per month (odds ratio 5 1.10; 95% confidence interval: 1.02-1.19; P 5 .02) in the post-PC period. CONCLUSIONS: After dexamethasone replaced prednisone as the most commonly prescribed steroid type for inpatients with asthma at our institution, we found no immediate changes in outcomes for asthmatic patients who were hospitalized but an upward trend in ICU transfers.

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Comparative Effectiveness of Dexamethasone versus Prednisone in Children Hospitalized with Asthma

Cited by 38 publications

References 18 publications

Identifying the “Blip on the Radar Screen”: Leveraging Big Data in Defining Drug Safety and Efficacy in Pediatric Practice

Identifying the “Blip on the Radar Screen”: Leveraging Big Data in Defining Drug Safety and Efficacy in Pediatric Practice

Is oral dexamethasone as good as oral prednisolone for childhood wheeze requiring steroids?

Outcomes for Pediatric Asthmatic Inpatients After Implementation of an Emergency Department Dexamethasone Treatment Protocol

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