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Topical intranasal corticosteroids and growth velocity in children: a meta-analysis
David J Mener1, Josef Shargorodsky, Ravi Varadhan
1Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
Insights
Intranasal topical corticosteroids (ITCs) may reduce short-term growth velocity in children with allergic rhinitis, but long-term effects remain unclear. Further research is needed to assess the impact on overall growth.
Area of Science:
- Pediatric Endocrinology
- Allergy and Immunology
- Pharmacology
Background:
- There is no established consensus on the impact of intranasal topical corticosteroids (ITCs) on growth velocity in pediatric populations.
- Allergic rhinitis (AR) is a common condition in children, often treated with ITCs.
Purpose of the Study:
- To determine if intranasal topical corticosteroid (ITC) use affects growth velocity in children diagnosed with allergic rhinitis (AR).
Main Methods:
- A comprehensive literature search was conducted across major databases (PubMed, EMBASE, SCOPUS, Cochrane) from 1988 to 2013.
- Included randomized clinical trials (RCTs) in children (<18 years) with AR, comparing ITCs to controls, and measuring growth velocity.
- Data from eligible studies were extracted, quality assessed, and pooled using a random-effects meta-analysis.
Main Results:
- Eight studies with 755 participants were included. Short-term growth velocity, measured by knemometry, was significantly reduced with ITC use (-0.223 mm/week; p < 0.034).
- Longer-term growth velocity, assessed by stadiometry over 12 months, showed no significant difference between ITC users and placebo (-0.053 cm/year; p = 0.813).
- Limitations include challenges in predicting long-term or catch-up growth.
Conclusions:
- Meta-analysis indicates that short-term ITC use for AR in children may lead to a decrease in short-term growth velocity.
- The effect of ITCs on longer-term growth velocity, as measured by stadiometry, remains uncertain.
- Further investigation is required to fully understand the long-term growth implications of ITCs in pediatric AR management.
Background:
There is no consensus regarding the effects on growth velocity of intranasal topical corticosteroid (ITC) use in children. The objective of this study was to determine whether ITC use reduces growth velocity in children with allergic rhinitis (AR).
Methods:
A literature search of the National Center for Biotechnology Information PubMed, EMBASE, SCOPUS, and Cochrane databases from January 1, 1988 to October 7, 2013. The study selection was composed of randomized clinical trials investigating ITC for treatment of AR in children (age <18 years of age) with appropriate controls. Studies must have included interval change in growth as an outcome. Two authors independently extracted data and assessed study quality. Eligible studies were pooled using a random-effects approach.
Results:
Eight studies with 755 participants from 3 countries provided data for the meta-analysis (knemometry, n =342 participants; stadiometry, n =413 participants). Study duration ranged from 2 to 4 weeks for trials evaluating knemometry outcomes, and 12 months for trials evaluating stadiometry outcomes. Age of participants ranged from 3 to 12 years. The pooled standardized mean difference showed that among studies using knemometry, mean growth was statistically significantly lower among children using ITC vs placebo (-.223 mm/week; 95% confidence interval [CI], -0.429 to -0.017; p < 0.034).The pooled standardized mean difference showed that among studies using stadiometry, there was no significant growth difference among children using ITC vs placebo (-0.053 cm/year; 95% CI, -0.491 to 0.385; p = 0.813). The limitations of this study were the difficulty in predicting longer-term or catch-up growth in children.
Conclusion:
Meta-analytic pooling of trials suggest that short-term ITC for the treatment of AR in children may decrease short-term growth velocity using knemometry; however, the effect on longer-term growth velocity as measured by stadiometry is unclear.
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