Effects of long-term maintenance therapy with a new glucocorticoid, deflazacort, on mineral metabolism and statural growth.
Deflazacort was substituted for Prednisone (based on the equivalence 1 mg Prednisone equals 1.2 mg Deflazacort), during maintenance glucocorticoid therapy in 9 children, 5 with renal diseases and 4 with connective tissue or immunoproliferative disorders. Six patients received 0.26-0.35 mg/kg body weight (B.W.)/day and 3 0.48-1.2 mg/kg B.W. on alternate days, for 10-16 months. Except for a child with chronic juvenile arthritis, who was also unresponsive to Prednisone, the therapeutic effects of Deflazacort were excellent. Steroid side effects present in 8 patients decreased or disappeared. Plasma Ca, P, Mg, creatinine, alkaline phosphatase, iPTH(1-34), urinary excretion of Ca, cAMP, and TRP remained normal. Plasma iPTH(1-84) remained normal in 5 children; in the other 4 patients it increased from normal to slightly elevated values. On Deflazacort, plasma calcidiol concentrations were within the normal range in 6/8 patients prescribed daily doses of vitamin D2 (1,600-2,400 IU) or calcidiol (20 micrograms). Plasma 1,25(OH)2D levels monitored in 5 children were also normal. The osteoporosis, evaluated on the tibial cortico-diaphyseal ratio and the trabecular aspect of bone radiograms, present in 5 patients, persisted in 1 and improved in the others. On Deflazacort, statural growth proceeded normally in all subjects, with a modest acceleration of growth velocity in 3 children. These results seem encouraging for extending clinical trials with Deflazacort to the active phase of pediatric diseases requiring glucocorticoid.
D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal; D001168:Arthritis / Q000188:drug therapy; D001827:Body Height; D001851:Bone Diseases, Metabolic / Q000139:chemically induced; D001842:Bone and Bones / Q000378:metabolism*; D002112:Calcifediol / Q000097:blood; D002118:Calcium / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D006130:Growth Disorders / Q000139:chemically induced*; D006801:Humans; D007674:Kidney Diseases / Q000188:drug therapy; D008297:Male; D008903:Minerals / Q000378:metabolism*; D010281:Parathyroid Hormone / Q000097:blood; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D011282:Pregnenediones / Q000009:adverse effects* / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D008903:Minerals; D010281:Parathyroid Hormone; D011282:Pregnenediones; C021988:deflazacort; D002112:Calcifediol; D002118:Calcium; D011241:Prednisone