Systemic Corticosteroids in the Treatment of Acute Vaso-occlusive Episodes in Sickle Cell Disease

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dc.contributor.advisorDickersin, Kayen_US
dc.contributor.authorBlack, Lucienen_US
dc.contributor.committeeMemberCasella, James F.en_US
dc.date.accessioned2015-02-11T04:17:03Z
dc.date.available2015-02-11T04:17:03Z
dc.date.created2014-05en_US
dc.date.issued2014-04-25en_US
dc.date.submittedMay 2014en_US
dc.description.abstractBackground: Vaso-occlusive episodes (VOEs) such as pain and acute chest syndrome (ACS) are the leading cause of hospitalization in patients with sickle cell disease (SCD) and a leading cause of morbidity. Moreover, ACS is a leading cause of death. Since these events are at least partially inflammatory in nature, systemic corticosteroids have been proposed as an adjunct to therapy, though use has been hampered by reports of rebound complications, especially pain. The objective of this study was to determine the role of corticosteroids in the treatment of patients with SCD hospitalized for a VOE. Methods: A systematic review with pre-defined eligibility criteria was performed. Studies were eligible for inclusion if they were randomized controlled trials in which patients with SCD hospitalized for a VOE received intravenous or oral corticosteroids or placebo. Planned analyses included the duration of hospitalization, duration of opioid therapy, percentage of patients readmitted with pain, and other adverse events. Results: Sixty-four citations were identified, of which three double-blind, randomized controlled trials were included. This represented a total of 110 VOEs (107 episodes in children, 3 in adults), of which 53 received corticosteroids and 57 received placebo. Meta-analysis showed a reduction in the length of hospitalization for ACS (mean difference 26.9 hours, 95% CI 12.2-41.6), a trend towards a shorter duration of opioid therapy, and fewer transfusions (RR 0.15, 95% CI 0.04-0.62) in patients receiving corticosteroids compared to those receiving placebo. However, a pooled analysis also showed a combined relative risk of 9.68 (95% CI 1.27-73.8) for readmission to the hospital for pain in the corticosteroid group compared to the placebo group. Conclusions: While potentially efficacious, corticosteroids should be used with caution in patients with SCD until further research is done. Thesis Readers: Kay Dickersin, PhD, and James Casella, MDen_US
dc.format.mimetypeapplication/pdfen_US
dc.identifier.urihttp://jhir.library.jhu.edu/handle/1774.2/37278
dc.languageen
dc.publisherJohns Hopkins University
dc.subjectSickle cellen_US
dc.subjectsteroidsen_US
dc.subjectpainen_US
dc.titleSystemic Corticosteroids in the Treatment of Acute Vaso-occlusive Episodes in Sickle Cell Diseaseen_US
dc.typeThesisen_US
dc.type.materialtexten_US
thesis.degree.departmentGraduate Training Program in Clinical Investigationen_US
thesis.degree.disciplineClinical Investigationen_US
thesis.degree.grantorJohns Hopkins Universityen_US
thesis.degree.grantorBloomberg School of Public Healthen_US
thesis.degree.levelMastersen_US
thesis.degree.nameSc.M.en_US
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