Corticosteroids do not impact growth velocity in children with eosinophilic esophagitis

April 09, 2024

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Key takeaways:

• Few studies have looked at how corticosteroids impact growth during eosinophilic esophagitis.
• There were no significant differences between corticosteroid and protein pump inhibitor use.

WASHINGTON — Swallowed corticosteroid treatment did not impact growth velocity among children with eosinophilic esophagitis, according to a poster presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

However, future studies with larger sample sizes would be necessary to determine the effect that this therapy has on linear growth, Ariana Yakuby, MD, pediatric resident, University at Buffalo, and colleagues wrote.

Data were derived from Yakuby A, et al. Poster 618. Presented at: AAAAI Annual Meeting; Feb. 23-26, 2023; Washington, D.C.

“There have been multiple studies that highlight the effects of steroid treatment on linear growth, particularly in asthmatic patients,” Yakuby said during her presentation. “However, there are limited studies that have examined these effects in patients with eosinophilic esophagitis.”

Ariana Yakuby

The single-center, retrospective chart review comprised 108 patients diagnosed with eosinophilic esophagitis stratified into groups aged 0 to 48 months, 49 to 132 months and older than 132 months.

Also, patients were prescribed 440 µg or 800 µg of fluticasone, 1,000 µg of budesonide or a protein pump inhibitor (PPI), which served as a control group.

“We compared these effects within their own age cohort,” Yakuby said.

Mean monthly growth velocities in the 0- to 48-month group included 0.637 cm among patients taking budesonide (n = 3), 0.5967 cm among those taking 440 µg of fluticasone (n = 6) and 0.6067 cm among those on PPI (n = 3).

“We did not see any significant difference in terms of linear growth velocity in all the treatment groups,” Yakuby said.

In the 49- to 132-month group, mean monthly growth velocities included 0.525 cm for the budesonide group (n = 4), 0.5327 cm for the group taking 440 µg of fluticasone (n = 15), 0.561 cm for the group taking 880 µg of fluticasone (n = 9) and 0.61 cm for the PPI group (n = 4).

Specifically, the researchers said the median monthly growth velocity of 0.44 cm among the group on 880 µg of fluticasone represented a decrease compared with the median of 0.544 cm in the PPI group between ages 49 and 132 months.

“However, this result was not statistically significant,” Yakuby said.

Among patients aged older than age 132 months, mean monthly growth velocities included 0.64 cm for those on 440 µg of fluticasone (n = 2), 0.2758 cm among those on 880 µg (n = 20) and 0.346 cm among those on PPI (n = 8). The researchers did not consider these differences to be significant either.

Yet Yakuby cautioned that the study has limitations that are important to consider. For example, she said the study may be underpowered due to its small sample sizes, particularly in its control group.

“Small sample sizes also make the likelihood of type 2 error high,” Yakuby said.

The researchers also excluded patients with complex medical histories that could limit growth development, such as patients who were treated with oral steroids for disorders beyond eosinophilic esophagitis. Patients were excluded because they were lost during follow-up or because they lacked data on growth or medication doses as well.

“Additionally, to maintain internal validity, the study only focused on initial swallow of corticosteroid treatment,” Yakuby said.

Further, the researchers only analyzed data from the first treatment for patients who were on multiple swallowed corticosteroid treatments.

Still, the researchers concluded that children who are being treated with swallowed corticosteroids for eosinophilic esophagitis did not experience any significant differences in growth velocity.

“Future investigations with larger sample sizes will be needed to fully determine the effect of inhaled corticosteroids on linear growth,” Yakuby said.

Reference:

Sources/Disclosures

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Source:

Yakuby A, et al. Poster 618. Presented at: AAAAI Annual Meeting; Feb. 23-26, 2023; Washington, D.C.

Disclosures:
Yakuby reports no relevant financial disclosures.

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