Oral systemic corticosteroids in children with acute asthma exacerbations: a systematic review and network meta-analysis.

Objective: To evaluate the efficacy differentials among corticosteroid regimens by type, dosage and duration, we conducted a systematic review and network meta-analysis of randomised controlled trials (RCTs).

Methods: We searched four databases from their inception to March 2024 and included RCTs that evaluated oral corticosteroids for asthma exacerbations in young people aged <21 years. We compared six regimens (dexamethasone (DEXA) 0.3 mg/kg/day administered for 1 day, DEXA 0.6 mg/kg/day for 1 day, DEXA 0.6 mg/kg/day for 2 days, prednisolone (PSL) 1.0 mg/kg/day for 3 days, PSL 1.0-1.5 mg/kg/day for 5 days and PSL 2.0 mg/kg/day for 5 days). Primary outcome was relapse within 14 days, defined as unplanned visit to an emergency department or primary care physician.

Results: Eleven studies involving 2353 patients were analysed in our quantitative synthesis. There were no significant differences in the relapse rates among 15 comparisons of six regimens. As part of the results, the network estimate showed that DEXA (0.3 mg/kg/day×1 day) compared with PSL (1.0 mg/kg/day for 3 days) had a risk ratio (RR) of 0.99 (95% CI 0.56 to 1.74), and DEXA (0.6 mg/kg/day for 2 days) compared with PSL (1.0-1.5 mg/kg/day×5 days) had an RR of 1.29 (95% CI 0.84 to 1.98). The certainty of the evidence for the included comparisons was low to very low.

Conclusion: In this network meta-analysis, there were no significant differences in the efficacy of commonly used corticosteroid regimens for acute exacerbations in childhood asthma. Short-term oral DEXA may be an acceptable alternative to a longer course of PSL.

Prospero registration number: CRD 42023449189.