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. 2015 Dec 9;2015(12):CD000407.
doi: 10.1002/14651858.CD000407.pub4.

Oral steroids for long-term use in cystic fibrosis

Katharine Cheng  1 , Deborah Ashby, Rosalind L Smyth
Affiliations

Oral steroids for long-term use in cystic fibrosis

Katharine Cheng et al. Cochrane Database Syst Rev. .

Abstract

Background: In cystic fibrosis (CF) airway obstruction and recurrent respiratory infection lead to inflammation, long-term lung damage, respiratory failure and death. Anti-inflammatory agents, e.g. oral corticosteroids are used since inflammation occurs early in disease. This is an update of a previously published review.

Objectives: To assess the effectiveness of oral corticosteroids in respiratory complications in CF, particularly lung function and adverse events. We examined long-term use (over 30 days) only.

Search methods: We searched the Cochrane CF and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.Most recent search: 28 August 2015.

Selection criteria: Randomised trials comparing oral corticosteroids given for more than 30 days with placebo or no additional therapy in people with CF.

Data collection and analysis: Two authors independently assessed study eligibility and quality.

Main results: Of eleven studies identified, three (354 participants) were included: two with four-year follow up and one with 12-weeks follow up. Data were lacking on predefined outcomes; common outcomes were examined at different time-points and presented differently. Meta-analyses were not possible.In one study, oral corticosteroids at prednisolone-equivalent dose of 1 mg/kg alternate days slowed progression of lung disease; at two and four years, % predicted FEV1 in the 1 mg/kg group changed significantly more than in the placebo group (P < 0.02). During the first two years, the 2 mg/kg group was not significantly different from the placebo group. Linear growth retardation was observed from six months in the 2 mg/kg alternate days prednisolone group and from 24 months in the 1 mg/kg alternate days prednisolone group.Adverse events terminated one four-year study early. Year 10 follow up showed catch-up growth started two years after treatment ceased. Alternate-day treatment with oral corticosteroids may have impaired growth until adulthood in boys.

Authors' conclusions: Oral corticosteroids at prednisolone-equivalent dose of 1 to 2 mg/kg alternate days appear to slow progression of lung disease in CF; benefit should be weighed against occurrence of adverse events. Risk-benefit analysis of low-dose alternate days corticosteroids is important. No further trials of this intervention are anticipated, and hence the review will no longer be regularly updated. However, if any new data are published, these will be incorporate when available.

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Conflict of interest statement

The lead author (KC) of this review has been employed by GlaxoSmithKline Research and Development Ltd since autumn 2004. GlaxoSmithKline does not produce or market any drugs that may fall into the scope of this review.

The remaining authors (RS and DA) declare no potential conflict of interest.

Figures

1.1
1.1. Analysis
Comparison 1: Oral corticosteroids (any dose) versus placebo, Outcome 1: Absolute change in per cent predicted FEV1
1.2
1.2. Analysis
Comparison 1: Oral corticosteroids (any dose) versus placebo, Outcome 2: Absolute change in per cent predicted FVC
1.3
1.3. Analysis
Comparison 1: Oral corticosteroids (any dose) versus placebo, Outcome 3: Growth retardation (at 4 years)
1.4
1.4. Analysis
Comparison 1: Oral corticosteroids (any dose) versus placebo, Outcome 4: Height at age over 18 years (boys)
1.5
1.5. Analysis
Comparison 1: Oral corticosteroids (any dose) versus placebo, Outcome 5: Height at over 18 years (girls)
1.6
1.6. Analysis
Comparison 1: Oral corticosteroids (any dose) versus placebo, Outcome 6: Absolute change in weight (kg)
1.7
1.7. Analysis
Comparison 1: Oral corticosteroids (any dose) versus placebo, Outcome 7: Weight at over 18 years (boys)
1.8
1.8. Analysis
Comparison 1: Oral corticosteroids (any dose) versus placebo, Outcome 8: Weight at over 18 years (girls)
1.9
1.9. Analysis
Comparison 1: Oral corticosteroids (any dose) versus placebo, Outcome 9: Adverse events
1.10
1.10. Analysis
Comparison 1: Oral corticosteroids (any dose) versus placebo, Outcome 10: Mortality
See this image and copyright information in PMC

Update of

References

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References to other published versions of this review

Cheng 1999
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Cheng 2013
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