© 1993 British Society for Rheumatology
Dose-Dependent Effects of Deflazacort and Prednisone on Growth and Skeletal Maturation
* Istituto di Puericultura e Medicina Neonatale ‘L. Gaslini’ Universita di Genova
Centro di Auxopatologia Infantile, III Clinica Pediatrica Universita di Torino
I Clinica Malattie Infettive Universita di Genova
Divisione di Nefrologia e Dialisi, Istituto G. Gaslini Genova
|| Clinica Pediatrica I. Universita di Genova
¶ Divisione di Nefrologia e Dialisi, Ospedale Infantile Regina Margherita Torino
** Divisione di Pediatria, Ospedale di Giaveno Torino
Divisione di Reumatologia, Cattedra di Puericultura, III Divisione di Pediatria Torino
Istituto di Statistica Medica e Biometria Universita di Milano, Italy
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Abstract |
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Deflazacort (DFZ), a new glucocorticoid which has recently become available, is expected to have less negative effects on growth and skeletal maturation than conventional steroids, in children treated long term. To verify this hypothesis, a multicentre trial was organized to evaluate the effects of DFZ vs prednisone (PDN) on statural growth and skeletal maturation in a group of prepubertal children requiring glucocorticoid therapy for at least 6 months/year. The results of an analysis of 55 children (aged 3–12 years, 24 with connective tissue disease and 31 with kidney glomerular disorders) treated randomly with either DFZ (31 patients) or PDN (24 patients) and followed for a mean period of about 22 months (16 months under steroid therapy) are presented. The observation period was split up into the following phases according to dose and administration regimen: daily, highdose therapy; alternate–day, high–dose therapy; low–dose therapy; suspension of treatment. The height, statural age, skeletal age and body weight velocities (i.e. the increase/year) were considered. In spite of large intra–individual and inter–individual variability, the results suggest that DFZ has a lower negative impact on indicators of growth. During high–dose daily administration, the height velocity tended to be lower in the PDN group and the impairment of skeletal maturity was significantly less for DFZ than for PDN. During an alternate–day regimen, height velocity was slightly higher in the PDN group and skeletal age velocity was higher in the DFZ group. It seems that steroid effects on statural growth and bone maturation occur in parallel. PDN induced a significantly greater increase in body weight than DFZ. It is worth noting that growth was not suppressed when low doses of DFZ or PDN were administered. During the suspended treatment phase, no prominent catch up growth was observed in either of the two treatment groups, as reflected by the statural indices.
KEY WORDS: Connective tissue disease, Glomerular disease, Deflazacort, Prednisone, Height velocity, Weight velocity