Effect of deflazacort versus methylprednisone on growth, body composition, lipid profile, and bone mass after renal transplantation. The Deflazacort Study Group.
Kidney function, growth velocity, weight/height ratio, body composition, lipid profile, and bone mass were studied in a randomized, multicenter trial of deflazacort versus methylprednisone in 27 prepubertal patients with kidney transplantation. Methylprednisone (0.20+/-0.03) was replaced by deflazacort (13 patients, 0.30+/-0.03 mg/kg per day). After 12 months, creatinine clearance decreased significantly only during methylprednisone therapy. Growth velocity increased only in patients treated with deflazacort from 3.3+/-0.6 to 5.6+/-0.5 cm/year. Serum levels of several components of the insulin-like growth factor axis did not change. Weight/height ratio was increased in methylprednisone-treated patients (P<0.05) and decreased in deflazacort-treated patients (P<0.005). Lean body mass increased in both groups (P<0.005). Fat body mass and serum leptin increased only in methylprednisone-treated patients (P<0.025). Total cholesterol and low-density lipoprotein-cholesterol increased in methylprednisone-treated patients by 9.9% (P<0.05) and 12.5% (P<0.025). High-density lipoprotein-cholesterol increased by 21% (P<0.005) and apolipoprotein B decreased by 11% (P<0.005) in deflazacort-treated patients. Total skeleton and lumbar spine bone mineral density decreased in both groups, but at 1 year methylprednisone-treated patients had lost 50% more bone. Bone mineral content decreased only in methylprednisone-treated patients (P<0.01). Our data suggest that substituting deflazacort for maintenance methylprednisone might prevent height loss, excessive bone loss, and fat accumulation; and leads to an improvement in the lipoproteins of these children.
Servicio de Nefrología Pediátrica, Hospital Italiano de Buenos Aires, Argentina.
J R
JR
Ferraris
T
T
Pasqualini
S
S
Legal
P
P
Sorroche
A M
AM
Galich
P
P
Pennisi
H
H
Domene
H
H
Jasper
D001823:Body Composition / Q000187:drug effects*; D015519:Bone Density / Q000187:drug effects*; D002648:Child; D002657:Child Development / Q000187:drug effects*; D005260:Female; D006128:Growth / Q000187:drug effects; D006133:Growth Substances / Q000097:blood; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D020738:Leptin / Q000097:blood; D008055:Lipids / Q000097:blood*; D011184:Postoperative Period; D011241:Prednisone / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D011282:Pregnenediones / Q000627:therapeutic use*
D006133:Growth Substances; D007166:Immunosuppressive Agents; D020738:Leptin; D008055:Lipids; D011282:Pregnenediones; C050574:6-methylprednisone; C021988:deflazacort; D011241:Prednisone