Oral Dexamethasone vs. Oral Prednisone for Children With Acute Asthma Exacerbations: A Systematic Review and Meta-Analysis

Abstract

Background: This systematic review and meta-analysis was conducted to compare relapse rates and adverse effects with oral dexamethasone vs. oral prednisone for acute asthma exacerbations in pediatric patients. Methods:A computerized literature search of PubMed, Embase, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials) and Google scholar databases was carried out till 1st August 2019. Six Randomized controlled trials (RCTs) and 1 quasi-RCT were included. Dosage of dexamethasone and prednisone varied across studies. Studies were grouped based on the follow-up period and duration of dexamethasone administration.Results: There was no significant difference in the relapse rate between dexamethasone and prednisone at 1-5 days (RR 1.46, 95%CI 0.69-3.7, P = 0.32; I 2 = 0%) and 10-15 days of follow up (RR 1.16, 95%CI 0.80-1.68, P = 0.44; I 2 = 0%). Pooled analysis found no significant difference in relapse rates with 1-day (RR 1.15, 95%CI 0.68-1.95, P = 0.60; I 2 = 0%) and 2-day dosage of dexamethasone (RR 1.25, 95%CI 0.82-1.92, P = 0.30; I 2 = 0%) compared to prednisone. Hospital readmission rates after initial discharge were not significantly different between the two drugs (RR 1.49, 95%CI 0.56-4.01, P = 0.43; I 2 = 0%). Frequency of vomiting at ED (RR 0.21, 95%CI 0.05-0.96, P = 0.04; I 2 = 50%) and at home (RR 0.42, 95%CI 0.25-0.69, P = 0.0007; I 2 = 0%) was significantly higher with prednisone as compared to dexamethasone.Conclusion: While our results indicate that both dexamethasone and prednisone have similar relapse rates when used for acute asthmatic exacerbations, strong conclusions cannot be drawn due to paucity of large scale RCTs and limited quality of evidence. Dexamethasone is however associated with lower incidence of vomiting as compared to prednisone. Further homogenous RCTs are needed to provide robust evidence on this topic.

Hospital's observed specific standard practice: A novel measure of variation in care for common inpatient pediatric conditions

“…For asthma, most of the variation was driven by differences in medication prescribing. Recent studies support the use of dexamethasone instead of prednisone for asthma exacerbations in the ED setting, demonstrating similar efficacy, less cost, improved parental compliance, and fewer side effects 28–33 . There is now uncertainty in appropriate prescribing practices for oral systemic steroids on the inpatient floors 34 .…”

“…Recent studies support the use of dexamethasone instead of prednisone for asthma exacerbations in the ED setting, demonstrating similar efficacy, less cost, improved parental compliance, and fewer side effects. [28][29][30][31][32][33] There is now uncertainty in appropriate prescribing practices for oral systemic steroids on the inpatient floors. 34 Because of the paucity of evidence on the equivalency of prednisolone and dexamethasone in the inpatient setting, we wondered how much of the variation in HOSSP was driven by differences in oral systemic corticosteroid prescribing.…”

Lebensrettende Maßnahmen bei Kindern (Paediatric Life Support, PLS)

“…Ältere Publikationen wurden berücksichtigt, wenn die Erkenntnisse als informativ angesehen werden konnten [ 388 – 393 ]. Das Suchupdate von Juni 2020 enthüllte zusätzlich eine Leitlinie [ 394 ], 3 SR [ 395 – 397 ], eine narrative Übersicht [ 398 ], ein RCT [ 399 ] und 4 Beobachtungsstudien [ 400 – 403 ]. Es wurden die von der Globalen Initiative für Asthma (ginasthma.org) und den französischen pädiatrischen Notfallgesellschaften veröffentlichten Leitlinien als qualitativ hochwertig eingestuft (AGREE II) und deshalb die Empfehlungen weitgehend darauf basiert [ 394 ].…”

Comparative effectiveness of oral dexamethasone vs. oral prednisolone for acute exacerbation of asthma: A randomized control trial

“…Asthma is a common pediatric disease that results in significant limitation of activity and an estimated loss of 14.4 million school days in children. [ 1 ] Acute exacerbation can be fatal and repeated asthma attacks have adverse impacts on a child’s lung function trajectory and also lead to poor quality of life and has psychological impact on mental wellbeing of children. [ 2 ]…”

“…Due to the long-acting nature of dexamethasone, different doses such as a single Intramuscular (IM) dose or two divided doses in 1 day or 2 days have been used. [ 1 ] Dexamethasone is being recognized as an attractive alternative to prednisolone because of its longer duration of action and shorter treatment period, leading to better compliance and improved clinical outcomes. [ 6 ]…”