P234 Impact Of Inhaled Corticosteroids On Growth In Children With Asthma: Systematic Review And Meta-analysis. (10th November 2014) - Loke, YK
Abstract : Background: There are major concerns and uncertainty regarding a possible reduction in growth velocity and final height of children with asthma who are long-term users of inhaled corticosteroids (ICS). We aimed to evaluate the association between ICS use of >12 months and growth. Methods: We initially searched MEDLINE and EMBASE in July 2013, followed by a PubMed search updated to June 2014. We used a combination of search terms involving drug names and adverse effects of interest (such as growth or height), and we also hand-searched reference lists of existing systematic reviews and trial reports. We selected RCTs and controlled observational studies of any ICS vs non-ICS control treatment in patients with asthma (treatment duration of at least 52 weeks). Meta-analysis of continuous outcomes (growth velocity in cm/year or final height in cm) was conducted using RevMan 5.3. We analysed mean differences using inverse variance method, random effects model. Heterogeneity was assessed using the I2 statistic. Results: We found 21 relevant studies (seventeen RCTs and four observational studies) after screening 1876 hits from the search. Meta-analysis of 16 RCTs showed a significant association between ICS use and reduction in growth velocity compared to controls (pooled Mean Difference -0.35cm/year, 95% CI -0.54 to -0.18). No significant reduction in growth velocity with ICS was reported in two observational studies of lower quality (pooled Mean Difference 0.03cm/year, 95% CI -0.61 to 0.67). Analysis of final adult height showed a mean reduction of -1.20 cm (95% CI -1.90 cm to – 0.50 cm) with budesonide versus placebo in a high quality RCT. Meta-analysis of two lower quality observational studies found a non-statistically significant pooled mean reduction in final adult height of -0.85 cm (95% CI -3.35 to 1.65). Conclusion: Use of ICS for 12 months or more in children with asthma has a limited impact on annual growth velocity, with a slight reduction in final adult height. When interpreted in the context of the typical final adult height in the UK, ICS users may experience less than 0.7% reduction in height compared to non-ICS users.