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. 2017 Jan 26;12(1):e0170259.
doi: 10.1371/journal.pone.0170259. eCollection 2017.

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

Fahad Aljebab  1 , Imti Choonara  1 , Sharon Conroy  1
Affiliations

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

Fahad Aljebab et al. PLoS One. .

Abstract

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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Conflict of interest statement

I have read the journal's policy and the authors of this manuscript have the following competing interests: Imti Choonara is an Academic Editor of the journal.

Figures

Fig 1
Fig 1. Flow chart of the literature search performed (PRISMA flow diagram).
Fig 2
Fig 2. Risk of bias summary and graph.
Fig 3
Fig 3. Relative risk of ADRs between prednisolone and dexamethasone for leukaemia patients.
Fig 4
Fig 4. Relative risk of hyperglycaemia between prednisolone and placebo in cystic fibrosis patients.
Fig 5
Fig 5. Relative risk of ADRs between prednisolone and budesonide in crohn's disease patients.
See this image and copyright information in PMC

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