R.E.B.E.L.EM.- By Anand Swaminathan - August 11, 2016
Article: Rehrer MW et al. A randomized controlled noninferiority trial of single dose of oral dexamethasone versus 5 days of oral prednisone in acute adult asthma. Ann Emerg Med 2016. PMID: 27117874
"Clinical Question:
Is a single dose of oral dexamethasone non-inferior to 5 days of oral prednisone in the treatment of adults with mild to moderate asthma exacerbations?
Author’s Conclusions: “A single dose of oral dexamethasone did not demonstrate noninferiority to prednisone for 5 days by a very small margin for treatment of adults with mild to moderate asthma exacerbations. Enhanced compliance and convenience may support the use of dexamethasone regardless”
Our Conclusions: The frequency of relapse was slightly higher with dexamethasone than prednisone (12.1% versus 9.8%),with an absolute difference was only 2.3%. Although this point estimate is below the preset upper limit for noninferiority, the upper limit of the confidence interval slightly exceeds the 8% difference set by the authors. As a result, this study does not establish noninferiority of single dose dexamethasone. However, due to issues of patient compliance with treatment regimens, a single dose of 12mg of dexamethasone by mouth seems like a reasonable alternative to a 5-day course of prednisone for adults with acute asthma exacerbations. A larger, multicenter trial investigating this intervention should be undertaken.
Potential Impact to Current Practice: The results of this study suggest that oral dexamethasone 12mg is either similar to or slightly inferior to a 5-day course of prednisone 60mg for adult patients with acute asthma exacerbations in the ED.
Clinical Bottom Line: A single dose of oral dexamethasone 12mg may be a reasonable alternative to a 5-day course of prednisone 60mg for adults with asthma exacerbations."