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Systematic Review of the Toxicity of Long-Course Oral Corticosteroids in Children

BACKGROUND: Long courses of oral corticosteroids are commonly used in children in the management of chronic conditions. Various adverse drug reactions (ADRs) are known to occur with their use. This systematic review aimed to identify the most common and serious ADRs and to determine their relative r...

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Autores principales: Aljebab, Fahad, Choonara, Imti, Conroy, Sharon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5268779/
https://www.ncbi.nlm.nih.gov/pubmed/28125632
http://dx.doi.org/10.1371/journal.pone.0170259
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author Aljebab, Fahad
Choonara, Imti
Conroy, Sharon
author_facet Aljebab, Fahad
Choonara, Imti
Conroy, Sharon
author_sort Aljebab, Fahad
collection PubMed
description BACKGROUND: Long courses of oral corticosteroids are commonly used in children in the management of chronic conditions. Various adverse drug reactions (ADRs) are known to occur with their use. This systematic review aimed to identify the most common and serious ADRs and to determine their relative risk levels. METHODS: A literature search of Embase, Medline, International Pharmaceutical Abstracts, CINAHL, Cochrane Library and PubMed was performed with no language restrictions in order to identify studies where oral corticosteroids were administered to patients aged 28 days to 18 years of age for at least 15 days of treatment. Each database was searched from their earliest dates to January 2016. All studies providing clear information on ADRs were included. RESULTS: One hundred and one studies including 33 prospective cohort studies; 21 randomised controlled trials; 21 case series and 26 case reports met the inclusion criteria. These involved 6817 children and reported 4321 ADRs. The three ADRs experienced by the highest number of patients were weight gain, growth retardation and Cushingoid features with respective incidence rates of 21.1%, 18.1% and 19.4% of patients assessed for these ADRs. 21.5% of patients measured showed decreased bone density and 0.8% of patients showed osteoporosis. Biochemical HPA axis suppression was detected in 269 of 487 patients where it was measured. Infection was the most serious ADR, with twenty one deaths. Varicella zoster was the most frequent infection (9 deaths). CONCLUSIONS: Weight gain, growth retardation and Cushingoid features were the most frequent ADRs seen when long-course oral corticosteroids were given to children. Increased susceptibility to infection was the most serious ADR.
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spelling pubmed-52687792017-02-06 Systematic Review of the Toxicity of Long-Course Oral Corticosteroids in Children Aljebab, Fahad Choonara, Imti Conroy, Sharon PLoS One Research Article BACKGROUND: Long courses of oral corticosteroids are commonly used in children in the management of chronic conditions. Various adverse drug reactions (ADRs) are known to occur with their use. This systematic review aimed to identify the most common and serious ADRs and to determine their relative risk levels. METHODS: A literature search of Embase, Medline, International Pharmaceutical Abstracts, CINAHL, Cochrane Library and PubMed was performed with no language restrictions in order to identify studies where oral corticosteroids were administered to patients aged 28 days to 18 years of age for at least 15 days of treatment. Each database was searched from their earliest dates to January 2016. All studies providing clear information on ADRs were included. RESULTS: One hundred and one studies including 33 prospective cohort studies; 21 randomised controlled trials; 21 case series and 26 case reports met the inclusion criteria. These involved 6817 children and reported 4321 ADRs. The three ADRs experienced by the highest number of patients were weight gain, growth retardation and Cushingoid features with respective incidence rates of 21.1%, 18.1% and 19.4% of patients assessed for these ADRs. 21.5% of patients measured showed decreased bone density and 0.8% of patients showed osteoporosis. Biochemical HPA axis suppression was detected in 269 of 487 patients where it was measured. Infection was the most serious ADR, with twenty one deaths. Varicella zoster was the most frequent infection (9 deaths). CONCLUSIONS: Weight gain, growth retardation and Cushingoid features were the most frequent ADRs seen when long-course oral corticosteroids were given to children. Increased susceptibility to infection was the most serious ADR. Public Library of Science 2017-01-26 /pmc/articles/PMC5268779/ /pubmed/28125632 http://dx.doi.org/10.1371/journal.pone.0170259 Text en © 2017 Aljebab et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Aljebab, Fahad
Choonara, Imti
Conroy, Sharon
Systematic Review of the Toxicity of Long-Course Oral Corticosteroids in Children
title Systematic Review of the Toxicity of Long-Course Oral Corticosteroids in Children
title_full Systematic Review of the Toxicity of Long-Course Oral Corticosteroids in Children
title_fullStr Systematic Review of the Toxicity of Long-Course Oral Corticosteroids in Children
title_full_unstemmed Systematic Review of the Toxicity of Long-Course Oral Corticosteroids in Children
title_short Systematic Review of the Toxicity of Long-Course Oral Corticosteroids in Children
title_sort systematic review of the toxicity of long-course oral corticosteroids in children
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5268779/
https://www.ncbi.nlm.nih.gov/pubmed/28125632
http://dx.doi.org/10.1371/journal.pone.0170259
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