Monthly Triamcinolone Acetonide for Severe, Refractory, Life-Threatening Asthma in Children

Abstract

RATIONALE: Conventional subgroup analyses in late-phase clinical trials are often conducted by calculating relative treatment effects for each trial endpoint within subgroups defined by baseline characteristics. For

Severe asthma in children—a review of definitions, epidemiology, and treatment options in 2019

“…The worrying side effects reported in one series 29 should be considered, albeit other case series did not mention side effects 27,30 and the fourth study mentioned only minor local effects. 28 As with most asthma treatments, response to triamcinolone is not homogeneous and results from one study indicate that a response may be more clearly seen in White children compared to Black.…”

“…44 The potential for harm from maintenance OCS to be greater than benefit is highlighted in BTS/SIGN guideline, 1 which states for adults (ie, those aged >12 years): "add on low dose oral corticosteroids F I G U R E 2 Schematic "ECG" summarizing the ups and downs of enthusiasm for many novel treatments, which have been used for severe asthma in the past, but which are no longer used. 8 In this metaphor, treatment is first proposed as being potentially of use (P-wave), then followed by a surge of enthusiasm (upwards limb of the QRS complex) followed by reality (downwards limb of the QRS complex), then a short burst of use by a few enthusiast (T-wave) after which the medication is never used Two retrospective case series published as separate abstracts 29,30 and which are summarized in Table 2, report beneficial and adverse treatment outcomes in a total of 12 children.…”

“…Collectively, these data should be considered with caution since their "open label" design, absence of placebo, and (in two cases 29,30 ) their retrospective design mean that it is not reasonable to infer beyond doubt that any benefits arose from triamcinolone treatment.…”

“…The authors conclude “Whether its [i.e.Triamcinolone] efficacy is due to improved compliance, or an improved anti‐inflammatory profile compared with oral steroids, remains unclear”. Two retrospective case series published as separate abstracts and which are summarized in Table , report beneficial and adverse treatment outcomes in a total of 12 children.…”

“…Collectively, these data should be considered with caution since their “open label” design, absence of placebo, and (in two cases) their retrospective design mean that it is not reasonable to infer beyond doubt that any benefits arose from triamcinolone treatment. The worrying side effects reported in one series should be considered, albeit other case series did not mention side effects and the fourth study mentioned only minor local effects . As with most asthma treatments, response to triamcinolone is not homogeneous and results from one study indicate that a response may be more clearly seen in White children compared to Black .…”