한빛사논문
- 조회344
Bohee Lee PhD a, Prof Steve Turner MBBS d, Prof Meredith Borland MBBS e, Péter Csonka PhD f,g, Prof Jonathan Grigg MD h, Prof Theresa W Guilbert MD i, Prof Tuomas Jartti MD j,k,l, Abraham Oommen MD m, Jonathan Twynam-Perkins MBChB b,n, Prof Steff Lewis PhD a,c, Prof Steve Cunningham PhD a,b
aAsthma UK Centre for Applied Research, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
bDepartment of Child Life and Health, Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
cUsher Institute, and Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
dRoyal Aberdeen Children's Hospital, NHS Grampian, Aberdeen, UK
ePerth Children's Hospital Emergency Department and Divisions of Paediatrics and Emergency Medicine, School of Medicine, University of Western Australia, WA, Australia
fTampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
gTerveystalo Healthcare, Tampere, Finland
hCentre for Genomics and Child Health, Queen Mary University of London, London, UK
iDivision of Pulmonology Medicine, Cincinnati Children's Hospital & Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
jDepartment of Pediatrics, Turku University Hospital and University of Turku, Turku, Finland
kPEDEGO Research Unit, University of Oulu, Oulu, Finland
lDepartment of Pediatrics, Oulu University Hospital, Oulu, Finland
mDepartment of Paediatrics, Milton Keynes University Hospital NHS Trust, Milton Keynes, UK
nDepartment of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
Correspondence to: Dr Bohee Lee
Abstract
Background: Oral corticosteroids are commonly used for acute preschool wheeze, although there is conflicting evidence of their benefit. We assessed the clinical efficacy of oral corticosteroids by means of a systematic review and individual participant data (IPD) meta-analysis.
Methods: In this systematic review with IPD meta-analysis, we systematically searched eight databases (PubMed, Ovid Embase, CINAHLplus, CENTRAL, ClinicalTrials.gov, EudraCT, EU Clinical Trials Register, WHO Clinical Trials Registry) for randomised clinical trials published from Jan 1, 1994, to June 30, 2020, comparing oral corticosteroids with placebo in children aged 12 to 71 months with acute preschool wheeze in any setting based on the Population, Intervention, Comparison, Outcomes framework. We contacted principal investigators of eligible studies to obtain deidentified individual patient data. The primary outcome was change in wheezing severity score (WSS). A key secondary outcome length of hospital stay. We also calculated a pooled estimate of six commonly reported adverse events in the follow-up period of IPD datasets. One-stage and two-stage meta-analyses employing a random-effects model were used. This study is registered with PROSPERO, CRD42020193958.
Findings: We identified 16 102 studies published between Jan 1, 1994, and June 30, 2020, from which there were 12 eligible trials after deduplication and screening. We obtained individual data from seven trials comprising 2172 children, with 1728 children in the eligible IPD age range; 853 (49·4%) received oral corticosteroids (544 [63·8%] male and 309 [36·2%] female) and 875 (50·6%) received placebo (583 [66·6%] male and 292 [33·4%] female). Compared with placebo, a greater change in WSS at 4 h was seen in the oral corticosteroids group (mean difference -0·31 [95% CI -0·38 to -0·24]; p=0·011) but not 12 h (-0·02 [-0·17 to 0·14]; p=0·68), with low heterogeneity between studies (I2=0%; τ2<0·001). Length of hospital stay was significantly reduced in the oral corticosteroids group (-3·18 h [-4·43 to -1·93]; p=0·0021; I2=0%; τ2<0·001). Subgroup analyses showed that this reduction was greatest in those with a history of wheezing or asthma (-4·54 h [-5·57 to -3·52]; pinteraction=0·0007). Adverse events were infrequently reported (four of seven datasets), but oral corticosteroids were associated with an increased risk of vomiting (odds ratio 2·27 [95% CI 0·87 to 5·88]; τ2<0·001). Most datasets (six of seven) had a low risk of bias.
Interpretation: Oral corticosteroids reduce WSS at 4 h and length of hospital stay in children with acute preschool wheeze. In those with a history of previous wheeze or asthma, oral corticosteroids provide a potentially clinically relevant effect on length of hospital stay.
논문정보
- Research article
- 2024년 03월 (BRIC 등록일 2024-03-27)
- 국외 연구진
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