Published online November 1, 2007
PEDIATRICS Vol. 120 No. 5 November 2007, pp. 1079-1087 (doi:10.1542/peds.2007-0667)
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STATE-OF-THE-ART REVIEW ARTICLE

Effects of Corticosteroid on Henoch-Schönlein Purpura: A Systematic Review

Pamela F. Weiss, MDa,b,c, James A. Feinstein, MDc, Xianqun Luan, MSd, Jon M. Burnham, MD, MSCEa,b,c and Chris Feudtner, MD, PhD, MPHb,c,e

a Division of Rheumatology
c Pediatric Generalist Research Group, Division of General Pediatrics
d Division of Biostatistics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
b Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
e Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania

ABSTRACT

OBJECTIVE. No consensus exists among general pediatricians or pediatric rheumatologists regarding whether corticosteroid therapy ameliorates the acute manifestations of Henoch-Schönlein purpura or mitigates renal injury. Therefore, we sought to synthesize the reported experimental and observational data regarding corticosteroid use.

METHODS. We performed a meta-analysis based on a comprehensive review of the literature in the Medline database (1956 to January 2007) and the Cochrane Controlled Trials Register. On the basis of reported outcomes among patients with Henoch-Schönlein purpura who were treated at diagnosis with corticosteroids compared with patients treated with supportive care only, we calculated odds ratios for the resolution of abdominal pain, the need for surgical intervention secondary to severe pain or intussusception, the likelihood of Henoch-Schönlein purpura recurrence, and the development of transient or persistent renal disease.

RESULTS. Of 201 articles retrieved from the initial literature search, 15 were eligible for inclusion. Corticosteroid treatment did not reduce the median time to resolution of abdominal pain but did significantly reduce the mean resolution time and increased the odds of resolution within 24 hours. Early corticosteroid treatment significantly reduced the odds of developing persistent renal disease. In addition, although the results were not statistically significant, the prospective data suggest reduced odds of both surgical intervention and recurrence.

CONCLUSIONS. Corticosteroids, given early in the course of illness, seem to produce consistent benefits for several major clinically relevant Henoch-Schönlein purpura outcomes.

Key Words: Henoch-Schönlein purpura • corticosteroids • children • meta-analytic methods • systematic reviews

Abbreviations: HSP—Henoch-Schönlein purpura • ESRD—end-stage renal disease • CCTR—Cochrane Controlled Trials Register • OR—odds ratio • CI—confidence interval

Accepted May 21, 2007.




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