Systematic Review of the Toxicity of Long-Course Oral Corticosteroids in Children.

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Term Occurence Count Dictionary
osteoporosis 2 endocrinologydiseases
cortisol 3 endocrinologydiseasesdrugs
dexamethasone 10 endocrinologydiseasesdrugs
methylprednisolone 1 endocrinologydiseasesdrugs

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Select Drug Character Offset Drug Term Instance
cortisol 13998 model, I2 = 0%, P = 0.02, RR = 1.88). (Fig 5). Some patients did not achieve adequate adrenal function ( cortisol level >18 μg/dL) until eight weeks after completion of therapy with dexamethasone [[57]]. Also some
cortisol 14148 completion of therapy with dexamethasone [[57]]. Also some children still had adrenal suppression ( cortisol level <18 μg/dL) after withdrawal of dexamethasone for up to 4–8 months [[58]]. One infant with a
cortisol 19965 children with HPA axis suppression during short course treatment returned to a normal level of endogenous cortisol secretion within 10–12 days after discontinuation of the corticosteroids [[2]].The three most commonly
dexamethasone 4209 remove duplications. The search strategy included all languages and involved the keywords "prednis* or dexamethasone or betamethasone" which are the most frequent medications given orally to children for long periods.
dexamethasone 8284 leukaemia, haemangioma, asthma, nephrotic syndrome, cystic fibrosis and Crohn’s disease. Prednisolone and dexamethasone were the most commonly used drugs.The studies included a total of 6817 patients and 4321 ADRs (Table
dexamethasone 12854 Meta-analysis across two RCTs [[27]][[28]] showed statistically significant hyperglycaemia associated with oral dexamethasone compared to oral prednisolone in leukaemic patients (Fixed model, I2 = 73%, P = 0.01, RR = 0.51). (Fig
dexamethasone 13287 2.73). (Fig 4).10.1371/journal.pone.0170259.g003Fig 3Relative risk of ADRs between prednisolone and dexamethasone for leukaemia patients.10.1371/journal.pone.0170259.g004Fig 4Relative risk of hyperglycaemia between
dexamethasone 14076 adequate adrenal function (cortisol level >18 μg/dL) until eight weeks after completion of therapy with dexamethasone [[57]]. Also some children still had adrenal suppression (cortisol level <18 μg/dL) after withdrawal
dexamethasone 14195 [[57]]. Also some children still had adrenal suppression (cortisol level <18 μg/dL) after withdrawal of dexamethasone for up to 4–8 months [[58]]. One infant with a haemangioma withdrew from treatment with oral prednisolone
dexamethasone 16403 patients received oral prednisolone [[28]][[63]][[89]][[96]], and two leukaemic patients received oral dexamethasone [[28]][[106]]. Another two children with Kearns-Sayre syndrome died from hyperglycaemia after receiving
dexamethasone 16585 from hyperglycaemia after receiving oral prednisolone [[92]]. Twenty children (six prednisolone, 14 dexamethasone ) with leukaemia died due to unknown reasons [[27]]. (Table 5).10.1371/journal.pone.0170259.t005Table
dexamethasone 17172 withdrawal, reported in three studies with nine leukaemia patients, all of whom were treated with oral dexamethasone [[27]][[28]][[98]]. Additionally growth retardation in four infants with haemangioma led to discontinuation
dexamethasone 19355 common in children.The risk of HPA axis suppression during long course corticosteroids was greater with dexamethasone than prednisolone in leukaemia patients [[29],[51]–[58]]. Also suppression was greater with oral corticosteroids
methylprednisolone 20717 observed side effect. The risk of this ADR was significantly greater with prednisolone than intravenous methylprednisolone [[22]]. Also the risk was significantly greater with boys than girls [[43]]. Comparing oral corticosteroids
Select Disease Character Offset Disease Term Instance
osteoporosis 1783 for these ADRs. 21.5% of patients measured showed decreased bone density and 0.8% of patients showed osteoporosis . Biochemical HPA axis suppression was detected in 269 of 487 patients where it was measured. Infection
osteoporosis 10328 behavioural change and sleep disturbance only [[50]][[65]].One study evaluated both blood pressure and osteoporosis [[49]].One study measured weight only [[46]].One study measured bone mineral density only [[42]].One

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