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Órgano Oficial del Colegio Mexicano de Alergia, Asma e Inmunología Pediátrica y de la Asociación Latinoamericana de Pediatría

2010, Number 1

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Alerg Asma Inmunol Pediatr 2010; 19 (1)

Efficiency and security of budesonide in the treatment of allergic rhinitis in children: A systematic review with meta-analysis

Pedro Gutiérrez-Castrellón P, Espinosa-Rosales F, Reynes-Manzur JN, López-Pérez G

Language: Spanish
References: 62
Page: 7-17
PDF size: 145.21 Kb.


ABSTRACT

Justification: The Allergic Rhinitis (RA) is more frequent chronic pathology in paediatric population. It has a significant impact in the quality of life (QoL), social interactions and comorbid conditions; producing effects direct, indirect and intangibles highly significatives. It is considered important to evaluate in systematic and exhaustive form the available evidence with the aim of identifying in form nonslanted the effectiveness and security of the Budesonide for the treatment of this pathology.
Study design: Systematic revision with meta-analyses in which we were only included studies clinical controlled, randomized, conducted in patients belower than 18 years old, with allergic rhinitis and that had received at least in one of the treatment arms budesonide via nasal, compared with placebo or some other antihistamine. The percentage of patients who received a total or almost total improvement of the nasal group of symptoms, the reduction in the average of nasal symptoms, the improvement in the average of the scale of quality of life (PRQLQ) and the improvement observed in the flow tip nasal level (FTNL), as well as the change in the percentage of eosinophils cells in nasal snot were considered ending variables. From the point of view of security the percentage of observed adverse events in each one of the groups of treatment was analyzed, the potential impact in the stature gain (cm) as well as the values of urinary cortisol fit by creatinine levels (urinary cortisol/creatinine). The calculation of reason of risks (RR) in the case of binary outcomes and average difference of averages (WMD) in the case of continuous outcomes took place. For all the considered calculation of the confidence interval to 95% (IC95%). Test of heterogeneity in all the cases using test of Chi square of Pearson, with a value of p ‹ 0.05 like synonymous of significance.
Results: Identify budesonide a positive effect in favor of in relation to the total or almost total improvement of the nasal group of symptoms [RR 1,66 (IC95% 1.33 to 2.07), p ‹ 0.0001], the reduction in the average of nasal symptoms [WMD -0.67 (IC95% -0.69 to -0.66), p ‹ 0.0001], the improvement in the average of the scale of quality of life or PRQLQ [WMD 0.16 (IC95% 0.14 to 0.18), p ‹ 0.01], and the improvement observed in the flow tip nasal level (FTNL) [WMD 21.4 (IC95% 19.6 to 23.2), p ‹ 0.0001]. From the point of view of security significant differences in relation to the percentage of adverse events observed in each one of the groups were not observed [RR 1.05 (IC95% 0.8 to 1.3), p = NS], nor in the stature gain (cm) [WMD -0.02 (IC95% -0.05 to 0.01), p = NS].
Conclusions: It is recommended that budesonide as an effective and safe alternative for the treatment of the allergic rhinitis in patients belower than18 years old when controlling almost in total form, in the majority of the patients the present symptoms, to reduce the average of the scales of evaluation of the nasal symptoms, to improve the quality of life as well as the nasal air flow, without producing adverse events in significant form, nor harmful effects in the growth.


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