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Deflazacort in juvenile chronic arthritis
1MRC Clinical Research Centre, Harrow, UK.
The Journal of Rheumatology. Supplement
|April 1, 1993
Summary
Deflazacort (DFZ) offers better bone sparing properties than prednisone (PRED) for children with juvenile chronic arthritis (JCA), showing improved spinal bone growth relative to somatic growth without compromising disease control.
Area of Science:
- Pediatric Rheumatology
- Endocrinology
- Bone Metabolism
Background:
- Glucocorticoid therapy, including prednisone (PRED), is associated with vertebral crush fractures and significant morbidity in juvenile chronic arthritis (JCA).
- Deflazacort (DFZ) is hypothesized to possess bone-sparing properties, potentially offering an advantage over PRED in managing JCA.
Purpose of the Study:
- To compare the efficacy and bone-sparing effects of deflazacort (DFZ) versus prednisone (PRED) in children with juvenile chronic arthritis (JCA).
- To evaluate the impact of DFZ and PRED on bone density trends, somatic growth, and disease control over a 1-year period.
Main Methods:
- A 1-year, double-blind, randomized, comparative trial involving 31 children with JCA receiving glucocorticoids.
- Patients were treated with either DFZ or PRED in equivalent doses, with bone density measured via dual photon absorptiometry at 3-month intervals.
- Covariance analysis was used to compare spinal bone density relative to body surface area and weight, alongside assessments of somatic growth.
Main Results:
- DFZ demonstrated similar disease control to PRED without significant differences in joint counts, hematological, or biochemical indices.
- Covariance analysis revealed a significant advantage for DFZ over PRED in maintaining spinal bone density relative to body size (p < 0.007).
- Children on DFZ experienced less weight gain but similar height gain compared to those on PRED; significant lumbar bone loss was observed only in the PRED group among children with poor somatic growth.
Conclusions:
- Deflazacort (DFZ) offers a significant bone-sparing advantage over prednisone (PRED) in children with JCA, with comparable disease control and safety profiles.
- DFZ treatment resulted in a significantly greater rate of spinal bone growth relative to somatic growth, particularly beneficial for children with impaired growth.
- These findings support DFZ as a potentially preferred glucocorticoid option for managing JCA to mitigate bone-related complications.