Harms of short-course systemic corticosteroids among children and adolescents: a systematic review and meta-analysis of randomized controlled trials

Abstract Introduction Short courses of systemic corticosteroids are used in the clinical management of a number of acute clinical conditions. In this systematic review and meta-analysis of randomized controlled trials we document the harms of the short-term use (≤ 14 days) of systemic corticosteroids in children and adolescents (1-18 years old) across different clinical conditions. Methods We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to January 2024 for randomized controlled trials evaluating the harms of short-course systemic corticosteroids We performed pairwise meta-analyses using the Mantel-Haenszel methods with risk difference. We assessed the certainty of evidence using the GRADE approach and subgroup analysis credibility with the ICEMAN instrument. PROSPERO registration (CRD42023400934). Results We identified 45 trials that included 6,470 children. Corticosteroids probably cause few if any serious adverse events (RD 1 fewer per 1000 [95% CI 9 fewer to 7 more]; moderate certainty), but probably do result in adverse events leading to discontinuation (RD 4 more per 1000 [95%CI 3 fewer to 11 more]; moderate certainty) compared to usual care. Corticosteroids probably increase the risk of hyperglycemia (RD 38 more per 1000 [95%CI 11 to 64 more]; moderate certainty), sleep problems (RD 15 more [95% CI 1 to 28 more]; moderate certainty), change in behavior (RD 8 more [95% CI 5 fewer to 21 more]; moderate certainty) and gastrointestinal bleeding (RD 13 more per 1000 [95% CI 3 to 23 more]; moderate certainty). Conclusion Corticosteroids likely increase the risk of hyperglycemia, sleep problems, change in behavior and gastrointestinal bleeding, but these adverse events are very seldom if ever serious.