Systematic review of the toxicity of short-course oral corticosteroids in children

BackgroundShort-course oral corticosteroids are commonly used in children but are known to be associated with adverse drug reactions (ADRs). This review aimed to identify the most common and serious ADRs and to determine their relative risk levels.MethodsA literature search of EMBASE, MEDLINE, International Pharmaceutical Abstracts, CINAHL, Cochrane Library and PubMed was performed with no language restrictions to identify studies in which oral corticosteroids were administered to patients aged 28 days to 18 years of age for up to and including 14 days of treatment. Each database was searched from their earliest dates to December 2013. All studies providing clear information on ADRs were included.ResultsThirty-eight studies including 22 randomised controlled trials (RCTs) met the inclusion criteria. The studies involved a total of 3200 children in whom 850 ADRs were reported. The three most frequent ADRs were vomiting, behavioural changes and sleep disturbance, with respective incidence rates of 5.4%, 4.7% and 4.3% of patients assessed for these ADRs. Infection was one of the most serious ADRs; one child died after contracting varicella zoster. When measured, 144 of 369 patients showed increased blood pressure; 21 of 75 patients showed weight gain; and biochemical hypothalamic–pituitary–adrenal axis suppression was detected in 43 of 53 patients.ConclusionsVomiting, behavioural changes and sleep disturbance were the most frequent ADRs seen when short-course oral corticosteroids were given to children. Increased susceptibility to infection was the most serious ADR.Trial registration numberCRD42014008774. By PROSPERO International prospective register of systematic reviews.

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LONG-COURSE ORAL CORTICOSTEROID TOXICITY IN CHILDREN

Archives of Disease in Childhood ◽

10.1136/archdischild-2016-311535.57 ◽

2016 ◽

Vol 101 (9) ◽

pp. e2.53-e2 ◽

Cited By ~ 1

Author(s):

Fahad Aljebab ◽

Imti Choonara ◽

Sharon Conroy

Keyword(s):

Weight Gain ◽

Growth Retardation ◽

Oral Prednisolone ◽

Incidence Rates ◽

Cochrane Library ◽

Varicella Zoster ◽

Susceptibility To Infection ◽

Oral Corticosteroids ◽

Long Course ◽

Increased Susceptibility

BackgroundLong courses of oral corticosteroids are commonly used in children in the management of conditions such as nephrotic syndrome, leukaemia, asthma and others. 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.MethodsA literature search of several databases; Embase, Medline, International Pharmaceutical Abstracts, CINAHL, the Cochrane Library and PubMed was performed to identify all studies where corticosteroids had been administered to paediatric patients ranging from 28 days to 18 years of age for at least 15 days of treatment. Each database was searched from their earliest dates to March 2014. All types of studies that provided clear information on ADRs were included.Results91 relevant studies were found from 27 countries. These studies represented a total of 6653 children and contained reports of 4124 ADRs, the majority in patients with leukaemia, haemangioma and asthma. Oral prednisolone was the most commonly prescribed corticosteroid (74% of patients). The three most frequent ADRs were weight gain, Cushingoid features and growth retardation. The incidence rates of patients with these three ADRs were 22.4%, 20.6% and 18.9%, respectively. Increased susceptibility to infection was the most serious ADR. 24 children died from infections, ten from varicella zoster and the others from different microorganisms.ConclusionsWeight gain, Cushingoid features and growth retardation were the most frequent ADRs seen when long-course oral corticosteroids were given to children. In addition, increased susceptibility to infection was the most common cause of mortality.

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SHORT-COURSE ORAL CORTICOSTEROID TOXICITY IN CHILDREN

Archives of Disease in Childhood ◽

10.1136/archdischild-2015-310148.36 ◽

2015 ◽

Vol 101 (1) ◽

pp. e1.30-e1

Author(s):

Fahad Ajebab ◽

Imti Choonara ◽

Sharon Conroy

Keyword(s):

Blood Pressure ◽

Relative Risk ◽

Adverse Events ◽

Hpa Axis ◽

Oral Prednisolone ◽

Incidence Rates ◽

Cochrane Library ◽

Behavioural Changes ◽

Short Course ◽

Oral Corticosteroids

BackgroundMultiple studies have evaluated and reported adverse drug reactions (ADRs) of corticosteroids. Short course oral corticosteroids are commonly used in children in the management of conditions such as asthma exacerbations. This systematic review aimed to identify the most common and serious ADRs associated with short courses of oral corticosteroids and to determine their relative risk levels in children.MethodsA literature search of the databases: Embase, Medline, International Pharmaceutical Abstracts, CINAHL, the Cochrane Library and PubMed was performed to identify all studies where corticosteroids had been administered to paediatric patients ranging from 28 days to 18 years of age for up to and including 14 days of treatment. Each database was searched from their earliest dates to December 2013. All types of studies that provided clear information on adverse events were included with no language restrictions. Quality assessments were performed on all studies by two independent reviewers.ResultsThirty eight studies met the inclusion criteria. These studies represented 3202 children and contained reports of 847 adverse events. The three most frequent ADRs were vomiting, increased blood pressure and behavioural changes. The incidence rates of these three ADRs were 6.3%, 8.5% and 4.8% of patients respectively. The risk of vomiting was greater with oral prednisolone than oral dexamethasone with a relative risk of 3.62 (95% CI 1.89, 6.95; P=0.0001). Prednisolone sodium phosphate was reported to cause vomiting less frequently than other prednisolone dosage forms (P=0.047). HPA axis suppression was detected in 43 of 53 patients who were tested. The relative risk of oral prednisolone to cause HPA axis suppression compared with inhaled steroids was 9.95 (95% CI 1.73, 53.03; P=0.010). Infection was one of the most serious ADRs, one child died after contracting a varicella zoster infection.ConclusionsVomiting, increased blood pressure and behavioural changes were the most frequent ADRs seen when short-course oral corticosteroids were given to children. In addition, infection was the most serious ADR. The majority of children who receive short course oral corticosteroids will experience HPA axis suppression.

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Side Effects of Short-Term Oral Corticosteroids

Journal of Cutaneous Medicine and Surgery ◽

10.2310/7750.2008.07029 ◽

2008 ◽

Vol 12 (2) ◽

pp. 77-81 ◽

Cited By ~ 31

Author(s):

Robert N. Richards

Keyword(s):

Side Effects ◽

General Hospital ◽

Treatment Options ◽

Review Literature ◽

Short Term ◽

Varicella Zoster ◽

Short Course ◽

Patient Consent ◽

Oral Corticosteroids ◽

Potential Risks

Background: Physicians frequently prescribe short-term corticosteroids (CSs) to treat acute and self-limiting diseases. Standard texts and articles do not usually discuss the possible, although infrequent, risks of short-term CSs. Objective: To demonstrate that side effects, although uncommon, can occur with short-term CSs and that these can occasionally be serious. Methods: Medline peer review literature in English (1985–2006) was searched to identify the potential risks of CSs. Standard textbooks of dermatology, gastroenterology, ophthalmology, pharmacology, respirology, and rheumatology were reviewed. Because the results showed some factual discordance and a dearth of precise data, the results for each body system were reviewed with two relevant clinical specialists at North York General Hospital (with at least 20 years' experience). Further information was obtained from a questionnaire of 200 physicians in North York General Hospital and by feedback from an additional 100 physicians during a presentation of this material at the American Academy of Dermatology. Results: Short-term CSs are generally safe, but there have been numerous reports of associated avascular necrosis and a few cases of fatal varicella-zoster in immunocompetent patients. Severe mood changes and psychotic reactions rarely occur unpredictably with short-term CSs. These events are rare, and most treatments with short-term CSs are problem free. Conclusions: Problems are infrequent, but patients must be informed of all material risks and treatment options. Thorough chart documentation is required, and patient consent must be given. CS doses should be as low as possible, and CS courses should be as infrequent and as short as possible. The literature reviewed in this article clearly indicates that a short course of CS of 1 week, in the absence of specific contraindications, is unlikely to be harmful (psychotic or prepsychotic episodes possibly excepted).

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Indicated preventive interventions for anxiety in children and adolescents: a review and meta-analysis of school based programs

10.31234/osf.io/jadxq ◽

2019 ◽

Author(s):

Siobhan Hugh-Jones ◽

Sophie Beckett ◽

Pavan Mallikarjun

Keyword(s):

Meta Analysis ◽

Child And Adolescent ◽

Sensitivity Analyses ◽

Cochrane Library ◽

Control Groups ◽

Adolescent Anxiety ◽

School Based ◽

Intervention Intensity ◽

Randomised Controlled ◽

And Control

Schools are promising sites for the delivery of prevention and early intervention programs to reduce child and adolescent anxiety. It is unclear whether universal or targeted approaches are most effective. This review and meta-analysis examines the effectiveness of school-based indicated interventions and was registered with PROSPERO [CRD42018087628].MEDLINE, EMBASE, PsycINFO and the Cochrane Library were searched for randomised controlled trials comparing indicated school programs for child and adolescent anxiety to active or inactive control groups. Twenty original studies, with 2076 participants, met the inclusion criteria and 18 were suitable for meta-analysis. Sub-group and sensitivity analyses explored intervention intensity, delivery agent and control type. A small beneficial effect was found for indicated programs compared to controls on self-reported anxiety symptoms at post-test (g = -0.28, CI = -0.50, -0.05, k= 18). The small effect was maintained at 6 (g = -0.35, CI= -0.58, -0.13, k = 9) and 12 months (g = -0.24, CI = -0.48, 0.00, k = 4). Based on two studies, >12 month effects were very small (g = -0.01, CI= -0.38, 0.36). No differences were found based on intervention intensity, delivery agent and control type. There was evidence of publication bias and a relatively high risk of contamination in studies. Findings support the value of school based indicated programs for child and adolescent anxiety. Effects at 12 months outperform many universal programs. High quality, randomised controlled and pragmatic trials are needed, with attention control groups and beyond 12 month diagnostic assessments are needed.

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Psychological interventions as an alternative and add-on to antidepressant medication to prevent depressive relapse: systematic review and meta-analysis

The British Journal of Psychiatry ◽

10.1192/bjp.2020.198 ◽

2020 ◽

pp. 1-8

Author(s):

Josefien Johanna Froukje Breedvelt ◽

Maria Elisabeth Brouwer ◽

Mathias Harrer ◽

Maria Semkovska ◽

David Daniel Ebert ◽

...

Keyword(s):

Psychological Intervention ◽

Meta Analysis ◽

Antidepressant Medication ◽

Cochrane Library ◽

Psychological Interventions ◽

Relapse Risk ◽

Increased Risk ◽

Antidepressant Use ◽

Randomised Controlled ◽

Risk Of Relapse

Background After remission, antidepressants are often taken long term to prevent depressive relapse or recurrence. Whether psychological interventions can be a viable alternative or addition to antidepressants remains unclear. Aims To compare the effectiveness of psychological interventions as an alternative (including delivered when tapering antidepressants) or addition to antidepressants alone for preventing depressive relapse. Method Embase, PubMed, the Cochrane Library and PsycINFO were searched from inception until 13 October 2019. Randomised controlled trials (RCTs) with previously depressed patients in (partial) remission where preventive psychological interventions with or without antidepressants (including tapering) were compared with antidepressant control were included. Data were extracted independently from published trials. A random-effects meta-analysis on time to relapse (hazard ratio, HR) and risk of relapse (risk ratio, RR) at the last point of follow-up was conducted. PROSPERO ID: CRD42017055301. Results Among 11 included trials (n = 1559), we did not observe an increased risk of relapse for participants receiving a psychological intervention while tapering antidepressants versus antidepressants alone (RR = 1.02, 95% CI 0.84–1.25; P = 0.85). Psychological interventions added to antidepressants significantly reduced the risk of relapse (RR = 0.85, 95% CI 0.74–0.97; P = 0.01) compared with antidepressants alone. Conclusions This study found no evidence to suggest that adding a psychological intervention to tapering increases the risk of relapse when compared with antidepressants alone. Adding a psychological intervention to antidepressant use reduces relapse risk significantly versus antidepressants alone. As neither strategy is routinely implemented these findings are relevant for patients, clinicians and guideline developers.

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Tele-health interventions to support self-management in adults with rheumatoid arthritis: a systematic review

Rheumatology International ◽

10.1007/s00296-021-04907-2 ◽

2021 ◽

Author(s):

Alison MacIver ◽

Hannah Hollinger ◽

Clare Carolan

Keyword(s):

Rheumatoid Arthritis ◽

Risk Of Bias ◽

Health Interventions ◽

Self Management ◽

Cochrane Library ◽

Bibliographic Databases ◽

Published Evidence ◽

Collection Form ◽

Randomised Controlled

AbstractRheumatoid arthritis (RA), a long-term auto-immune condition is a challenging condition for patients to manage. Goals of treatment include reducing pain, decreasing inflammation, and improving an individual’s overall function. Increasingly technology is being utilised to support patients to self-manage their condition. The aim of this systematic narrative review was to synthesise and critically appraise published evidence concerning the effectiveness of tele-health interventions to support self-management in RA. Bibliographic databases searched from 2014 to March 2020 included MedLINE, Embase, Cochrane Library. Search strategy combined the following concepts: (1) rheumatoid arthritis, (2) tele-health interventions, and (3) self-management. Only randomised controlled trials (RCTs) involving adults with RA were included. Titles, abstracts, full-text articles were screened, any discrepancies were checked by a second reviewer. Risk of bias was assessed using Cochrane risk of bias tool and data were extracted utilising the Cochrane data collection form for RCT interventions along with the TiDier checklist. Due to high heterogeneity, results were not meta-analysed and instead data were synthesised narratively. The search identified 98 articles, seven were included. The completed RCTs varied in the nature of the interventions, duration/severity of RA, outcomes measured and effectiveness of the interventions. The completed RCTs included a total of 791 participants Disease duration was largely between 4 and 10 years and disease severity on average was moderate. There was extensive variation in intervention components, theories underpinning theories and outcomes measured. Five RCTs reported a positive effect on factors such as disease activity, medication adherence, physical activity and self-efficacy levels. This study suggests that tele-health interventions that are well-designed, tailored and multi-faceted can help to achieve positive self-management outcomes in RA. None of the studies showed evidence of harm.

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Effectiveness of workplace exercise interventions in the treatment of musculoskeletal disorders in office workers: a protocol of a systematic review

BMJ Open ◽

10.1136/bmjopen-2020-038854 ◽

2020 ◽

Vol 10 (12) ◽

pp. e038854

Author(s):

Carlos Tersa-Miralles ◽

Roland Pastells-Peiró ◽

Francesc Rubí-Carnacea ◽

Filip Bellon ◽

Esther Rubinat Arnaldo

Keyword(s):

Systematic Review ◽

Musculoskeletal Disorders ◽

Exercise Intervention ◽

Meta Analysis ◽

Office Workers ◽

Cochrane Library ◽

Exercise Interventions ◽

Physical Strength ◽

Prolonged Sitting ◽

Randomised Controlled

IntroductionPhysical inactivity due to changes in our society towards more sedentary behaviours is leading to health problems. Increasing physical activity might be a good strategy to improve physical strength and reduce the prevalence of illnesses associated with prolonged sitting. Office workers exhibit a sedentary lifestyle with short rest periods or even without pauses during the workday. It is important to perform workplace interventions to treat musculoskeletal disorders caused by prolonged sitting and lack of movement adopted on the office setting. This article describes a protocol for a systematic review to evaluate the effectiveness of exercise interventions on office workers in their work environment.Methods and analysisA literature search will be performed in the PubMed, CINAHL Plus, Cochrane Library, Scopus, ISI WoS and PeDRO databases for randomised controlled trials and studies published from 1 January 2010 to 31 July 2020 in English or Spanish. The participants will be office workers who spend most of their work time in a sitting position. The interventions performed will include any type of exercise intervention in the workplace. The outcome measures will vary in accordance with the aim of the intervention observed. The results of the review and the outcomes from the studies reviewed will be summarised with a narrative synthesis. The review protocol was developed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines.Ethics and disseminationEthical approval is not required. The review outcomes and the additional data obtained will be disseminated through publications and in scientific conferences.PROSPERO registration numberCRD42020177462.

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Maintaining musculoskeletal health using a behavioural therapy approach: a population-based randomised controlled trial (the MAmMOTH Study)

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-219091 ◽

2021 ◽

pp. annrheumdis-2020-219091 ◽

Cited By ~ 1

Author(s):

Gary J Macfarlane ◽

Marcus Beasley ◽

Neil Scott ◽

Huey Chong ◽

Paul McNamee ◽

...

Keyword(s):

Quality Of Life ◽

High Risk ◽

Primary Outcome ◽

Population Based ◽

Behavioural Therapy ◽

Short Course ◽

Life Years ◽

Secondary Outcomes ◽

Randomised Controlled

ObjectiveCognitive–behavioural therapy (CBT) has been shown to be effective in the management of chronic widespread pain (CWP); we now test whether it can prevent onset among adults at high risk.MethodsA population-based randomised controlled prevention trial, with recruitment through UK general practices. A mailed screening questionnaire identified adults at high risk of CWP. Participants received either usual care (UC) or a short course of telephone CBT (tCBT). The primary outcome was CWP onset at 12 months assessed by mailed questionnaire. There were seven secondary outcomes including quality of life (EuroQol Questionnaire-five dimensions-five levels/EQ-5D-5L) used as part of a health economic assessment.Results996 participants were randomised and included in the intention-to-treat analysis of which 825 provided primary outcome data. The median age of participants was 59 years; 59% were women. At 12 months there was no difference in the onset of CWP (tCBT: 18.0% vs UC: 17.5%; OR 1.05; 95% CI 0.75 to 1.48). Participants who received tCBT were more likely to report better quality of life (EQ-5D-5L utility score mean difference 0.024 (95% CI 0.009 to 0.040)); and had 0.023 (95% CI 0.007 to 0.039) more quality-adjusted life-years at an additional cost of £42.30 (95% CI −£451.19 to £597.90), yielding an incremental cost-effectiveness ratio of £1828. Most secondary outcomes showed significant benefit for the intervention.ConclusionsA short course of tCBT did not prevent onset of CWP in adults at high risk, but improved quality of life and was cost-effective. A low-cost, short-duration intervention benefits persons at risk of CWP.Trial registration numberClinicalTrials.gov Registry (NCT02668003).

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Do the combined blood pressure effects of exercise and antihypertensive medications add up to the sum of their parts? A systematic meta-review

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2020-000895 ◽

2021 ◽

Vol 7 (1) ◽

pp. e000895

Author(s):

Linda S Pescatello ◽

Yin Wu ◽

Simiao Gao ◽

Jill Livingston ◽

Bonny Bloodgood Sheppard ◽

...

Keyword(s):

Blood Pressure ◽

Strong Evidence ◽

Pressure Effects ◽

Cochrane Library ◽

Antihypertensive Medications ◽

Eligibility Criteria ◽

Physical Activity Guidelines ◽

Meta Review ◽

Randomised Controlled ◽

Meta Analyses

ObjectiveTo compare the blood pressure (BP) effects of exercise alone (EXalone), medication alone (MEDSalone) and combined (EX+MEDScombined) among adults with hypertension.Data sourcesPubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus and the Cochrane Library.Eligibility criteriaRandomised controlled trails (RCTs) or meta-analyses (MAs) of controlled trials that: (1) involved healthy adults>18 year with hypertension; (2) investigated exercise and BP; (3) reported preintervention and postintervention BP and (4) were published in English. RCTs had an EX+MEDScombined arm; and an EXalone arm and/or an MEDSalone arm; and MAs performed moderator analyses.DesignA systematic network MA and meta-review with the evidence graded using the Physical Activity Guidelines for Americans Advisory Committee system.OutcomeThe BP response for EXalone, MEDSalone and EX+MEDScombined and compared with each other.ResultsTwelve RCTs qualified with 342 subjects (60% women) who were mostly physically inactive, middle-aged to older adults. There were 13 qualifying MAs with 28 468 participants (~50% women) who were mostly Caucasian or Asian. Most RCTs were aerobic (83.3%), while the MAs involved traditional (46%) and alternative (54%) exercise types. Strong evidence demonstrates EXalone, MEDSalone and EX+MEDScombined reduce BP and EX+MEDScombined elicit BP reductions less than the sum of their parts. Strong evidence indicates EX+MEDScombined potentiate the BP effects of MEDSalone. Although the evidence is stronger for alternative than traditional types of exercise, EXaloneelicits greater BP reductions than MEDSalone.ConclusionsThe combined BP effects of exercise and medications are not additive or synergistic, but when combined they bolster the antihypertensive effects of MEDSalone.PROSPERO registration numberThe protocol is registered at PROSPERO CRD42020181754.

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Improving perinatal sleep via a scalable cognitive behavioural intervention: findings from a randomised controlled trial from pregnancy to 2 years postpartum

Psychological Medicine ◽

10.1017/s0033291721001860 ◽

2021 ◽

pp. 1-11

Author(s):

Bei Bei ◽

Donna M. Pinnington ◽

Nina Quin ◽

Lin Shen ◽

Michelle Blumfield ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Sleep Disturbance ◽

Controlled Trial ◽

Perinatal Care ◽

Group Differences ◽

Behavioural Intervention ◽

Cognitive Behavioural ◽

Pregnancy And Postpartum ◽

Randomised Controlled ◽

Insomnia Symptoms

Abstract Background Sleep disturbance is common in gestational parents during pregnancy and postpartum periods. This study evaluated the feasibility and efficacy of a scalable cognitive behavioural therapy (CBT) sleep intervention tailored for these periods. Methods This is a two-arm, parallel-group, single-blind, superiority randomised controlled trial. Nulliparous females without severe medical/psychiatric conditions were randomised 1:1 to CBT or attention- and time-matched control. All participants received a 1 h telephone session and automated multimedia emails from the third trimester until 6 months postpartum. Outcomes were assessed with validated instruments at gestation weeks 30 (baseline) and 35 (pregnancy endpoint), and postpartum months 1.5, 3, 6 (postpartum endpoint), 12 and 24. Results In total, 163 eligible participants (age M ± s.d. = 33.35 ± 3.42) were randomised. The CBT intervention was well accepted, with no reported adverse effect. Intention-to-treat analyses showed that compared to control, receiving CBT was associated with lower insomnia severity and sleep disturbance (two primary outcomes), and lower sleep-related impairment at the pregnancy endpoint (p values ⩽ 0.001), as well as at 24 months postpartum (p ranges 0.012–0.052). Group differences across the first postpartum year were non-significant. Participants with elevated insomnia symptoms at baseline benefitted substantially more from CBT (v. control), including having significantly lower insomnia symptoms throughout the first postpartum year. Group differences in symptoms of depression or anxiety were non-significant. Conclusions A scalable CBT sleep intervention is efficacious in buffering against sleep disturbance during pregnancy and benefitted sleep at 2-year postpartum, especially for individuals with insomnia symptoms during pregnancy. The intervention holds promise for implementation into routine perinatal care.

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