Two new systematic reviews published in The Cochrane Library focus on the effects of inhaled corticosteroid drugs (ICS) on growth rates.
The authors found children’s growth slowed in the first year of treatment, although the effects were minimized by using lower doses.
Inhaled corticosteroids are prescribed as first-line treatments for adults and children with persistent asthma.
They are the most effective drugs for controlling asthma and clearly reduce asthma deaths, hospital visits and the number and severity of exacerbations, and improve quality of life.
Yet, their potential effect on the growth of children is a source of worry for parents and doctors.
Worldwide, seven ICS drugs are currently available: beclomethasone, budesonide, ciclesonide, flunisolide, fluticasone, mometasone and triamcinolone.
Ciclesonide, fluticasone and mometasone are newer and supposedly safer drugs.
The first systematic review focused on 25 trials involving 8,471 children up to 18 years old with mild to moderate persistent asthma.
These trials tested all available inhaled corticosteroids except triamcinolone and showed that, as a group, they suppressed growth rates when compared to placebos or non-steroidal drugs. 14 of the trials, involving 5,717 children, reported growth over a year.
The average growth rate, which was around 6-9 cm per year in control groups, was reduced by about 0.5 cm in treatment groups.
The researchers found that growth suppression varied across studies, and so they looked at the relationship between a variety of factors and their effects on growth. Some of the variation could be explained by the drugs used, although since this was an indirect comparison the authors say more evidence is needed.
“Conclusions about the superiority of one drug over another should be confirmed by further trials that directly compare the drugs,” said Zhang.
More long-term trials and trials comparing different doses are also needed, particularly in children with more severe asthma requiring higher doses of inhaled corticosteroids, the researchers conclude.
“Only 14% of the trials we looked at monitored growth in a systematic way for over a year. This is a matter of major concern given the importance of this topic,” said Francine Ducharme, one of the authors of both reviews and senior author of the second review, based at the Department of Paediatrics at the University of Montreal in Montreal, Canada.
“We recommend that the minimal effective dose be used in children with asthma until further data on doses becomes available. Growth should be carefully documented in all children treated with inhaled corticosteroids, as well in all future trials testing inhaled corticosteroids in children.”
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