Effects of Deflazacort vs Methylprednisone on growth and bone mineral density in a randomized study in kidney transplant patients

ALONSO G; PASQUALINI T; GALICH A; JASPER H; FERRARIS J; AND THE DEFLAZACORT STUDY GROUP

Viña del Mar, Chile

Congreso; XVIII Reunión Anual, Sociedad Latinoamericana de Endocrinología Pediátrica; 2006

Sociedad Latinoamericana de Endocrinología Pediátrica

EFFECTS OF DEFLAZACORT (D) VS. METHYLPREDNISONE (MP) ON GROWTH AND BONE MINERAL DENSITY IN A RANDOMIZED STUDY IN KIDNEY TRANSPLANT PATIENTS (TX). Alonso G, Pasqualini T, Galich A M, Jasper H, Ferraris J R y the Deflazacort Study Group. Sección Endocrinología y Sección Trasplante Renal, Departamento Pediatría; Servicio de Endocrinología, Hospital Italiano; División Endocrinología, Hospital de Niños R Gutiérrez; Buenos Aires, ArgentinaDespite their side effects, glucocorticoids are the stonecorner of immunosuppression in renal transplantation. We have previously shown that substituting methylprednisone for deflazacort, an oxazoline analog of prednisolone, resulted in an improvement in growth and in the dislipoproteinemia. In this study, we report linear growth and body composition after 3 years of substitution of MP for D. Patients and Methods; 30 prepuberal patients (female: 6), mean age at the start of the study 9.2 + 2.2 years, were randomized to treatment with MP or D at equivalent doses, 2.1 + 0.4 years post Tx; 15 patients persisted on MP and 15 were switched to D. We evaluated anthropometric variables (weight, height, BMI, growth velocity); bone variables [lumbar bone mineral density (BMD-L), bone mineral content (BMC) by DXA] and body composition (lean and fat mass by DXA, Lunar XPL). We present basal data and after 3 years of follow-up. Results: mean (SE) (D vs MP). Basal and 3rd year height, and basal weight/height relationship were not different. At 3rd year weight/height relationship was + 8.8 % (4.6) in D and +28% (6.7) in MP groups (p<0.05); height gain, 13.3 (1.3) cm in D and 8.4 (0.8) cm in MP (p<0.05). BMD-L Z score and BMC were not different at basal neither after 3 years of treatment. Fat mass gain was minor in D than in MP group +833.4 (732.5) vs +4359.2 (1428.2) gr, p0.04; and lean mass gain was bigger in D than in MP group +4548.9 (671.8) vs 2601.7 (328.1) gr, p0.02. There were a positive correlation between BMD-L and patient height, r=0.51, p<0.01, and BMC and lean mass, r=0.89, p<0.01. Conclusion: Our data suggest that deflazacort therapy might improve linear growth and lean body mass; and prevent fat accumulation. The correlation between BMC and lean mass discloses that the mechanostat is still important in these patients.