Beschreibung:
<jats:title>Abstract</jats:title><jats:sec><jats:title>Objectives</jats:title><jats:p>While systemic corticosteroids (<jats:styled-content style="fixed-case">SCS</jats:styled-content>) are widely used to prevent relapse in adults with acute asthma discharged from the emergency department, the most effective route of administration is unclear. The objective of this review was to examine the effectiveness of <jats:styled-content style="fixed-case">SCS</jats:styled-content> in adults and to identify the most effective route of <jats:styled-content style="fixed-case">SCS</jats:styled-content> to preventing relapse.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A search was conducted to identify randomized controlled trials comparing the effectiveness of intramuscular (<jats:styled-content style="fixed-case">IM</jats:styled-content>) or oral (<jats:styled-content style="fixed-case">PO</jats:styled-content>) short‐course or long‐course corticosteroids to prevent relapse in adults with acute asthma. Two independent reviewers judged study relevance, inclusion, and risk of bias. Pooled statistics were calculated as risk ratios (<jats:styled-content style="fixed-case">RR</jats:styled-content>) and odds ratios (<jats:styled-content style="fixed-case">OR</jats:styled-content>) with 95% confidence intervals (<jats:styled-content style="fixed-case">CI</jats:styled-content>) and credibility intervals (CrI) using a random‐effects model. A Bayesian network meta‐analysis was performed for indirect comparisons of <jats:styled-content style="fixed-case">SCS</jats:styled-content> to placebo. Probability of best (<jats:styled-content style="fixed-case">PB</jats:styled-content>) analysis was reported for comparisons between the routes of administration.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Thirteen studies of moderate quality were included. Four studies compared <jats:styled-content style="fixed-case">SCS</jats:styled-content> to placebo, in which <jats:styled-content style="fixed-case">SCS</jats:styled-content> significantly reduced relapse (<jats:styled-content style="fixed-case">RR</jats:styled-content> = 0.43; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> = 0.25 to 0.74). In the network meta‐analysis, a significant reduction in relapse within 10 days of discharge was found in adults receiving <jats:styled-content style="fixed-case">IM</jats:styled-content> (<jats:styled-content style="fixed-case">OR</jats:styled-content> = 0.21; 95% CrI = 0.05 to 0.73) and <jats:styled-content style="fixed-case">PO</jats:styled-content> long‐course (<jats:styled-content style="fixed-case">OR</jats:styled-content> = 0.31; 95% CrI = 0.09 to 0.95) corticosteroids. Relapse rates between <jats:styled-content style="fixed-case">PO</jats:styled-content> short‐course corticosteroids and placebo were not statistically significantly different (<jats:styled-content style="fixed-case">OR</jats:styled-content> = 0.37; 95% CrI = 0.04 to 3.38). <jats:styled-content style="fixed-case">PB</jats:styled-content> analysis favored <jats:styled-content style="fixed-case">IM</jats:styled-content> corticosteroids (62%) followed by <jats:styled-content style="fixed-case">PO</jats:styled-content> short‐course (20.3%) and <jats:styled-content style="fixed-case">PO</jats:styled-content> long‐course (14.1%) corticosteroids.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The network analysis identified <jats:styled-content style="fixed-case">IM</jats:styled-content> corticosteroids and <jats:styled-content style="fixed-case">PO</jats:styled-content> long‐course corticosteroids as the most effective strategies to prevent relapse among adults with acute asthma, compared to <jats:styled-content style="fixed-case">PO</jats:styled-content> short‐course corticosteroids. The lack of significant findings with <jats:styled-content style="fixed-case">PO</jats:styled-content> short‐course corticosteroids is likely due to the paucity of research. Further comparative studies are required to determine the safety and effectiveness of briefer <jats:styled-content style="fixed-case">PO SCS</jats:styled-content> treatment options in adults.</jats:p></jats:sec>