Dexamethasone versus methylprednisolone for critical asthma: A single center, open‐label, parallel‐group clinical trial

Abstract

Background: Evidence for the use of dexamethasone for pediatric critical asthma is limited. We sought to compare the clinical efficacy and safety of dexamethasone versus methylprednisolone among children hospitalized in the pediatric intensive care unit (PICU) for critical asthma. Methods: A prospective, single center, open-label, two-arm, parallel-group, nonrandomized trial among children ages 5−17 years hospitalized within the PICU from April 2019 to December 2021 for critical asthma consented to receive methylprednisolone (standard care) or dexamethasone (intervention) at a 2:1 allocation ratio, respectively. The intervention arm received intravenous dexamethasone 0.25 mg/kg/dose (max: 15 mg/dose) every 6 h for 48 h and the standard care arm intravenous methylprednisolone 1 mg/kg/dose every 6 h (max dose: 60 mg/ dose) for 5 days. Study endpoints were clinical efficacy (i.e., length of stay [LOS], continuous albuterol duration, and a composite of adjunctive asthma interventions)and safety (i.e., corticosteroid-related adverse events).Results: Ninety-two participants were analyzed of whom 31 were allocated to the intervention arm and 61 the standard care arm. No differences in demographics, clinical characteristics, or acute/chronic asthma severity indices were observed. Regarding efficacy and safety endpoints, no differences in hospital LOS, continuous albuterol duration, adjunctive asthma intervention rates, or corticosteroid-related adverse events were noted. Compared to the intervention arm, participants in the standard care arm more frequently were prescribed corticosteroids at discharge (72% vs. 13%, p < 0.001).Conclusions: Among children hospitalized for critical asthma, dexamethasone appears safe and warrants further investigation to fully assess clinical efficacy and potential advantages over commonly applied agents such as methylprednisolone.

Revisiting dexamethasone use in the pediatric emergency department

“…Much of the recent literature focuses on ongoing treatment of status asthmaticus in pediatric critical care units where it has been found that dexamethasone was not inferior to methylprednisone or hydrocortisone when comparing steroid's effect on length of time on continuous albuterol while hospitalized [27]. Dosing comparisons of methylprednisone 1 mg/kg/dose q6 h (max of 60 mg) versus dexamethasone 0.25 mg/kg/dose q6 h (max 15 mg) showed no difference in the hospital length of stay, duration of continuous albuterol or additional adjunctive medications [28 ▪▪ ].…”

Pediatric Pulmonology 2023 Year in Review: Asthma

“…Dexamethasone is a promising option for systemic steroids given its dosing frequency and half-life. Roddy et al performed a single center, parallel group prospective study comparing IV dexamethasone and IV methylprednisolone during acute asthma exacerbations in the pediatric intensive care unit (PICU) 20 . Children 5-17 years of age were eligible to participate.…”