Premium
Clinical effect of corticosteroids in asthma‐affected horses: A quantitative synthesis
Author(s) -
Calzetta L.,
Rogliani P.,
Page C.,
Roncada P.,
Pistocchini E.,
Soggiu A.,
Piras C.,
Urbani A.,
Matera M.G.
Publication year - 2018
Publication title -
equine veterinary journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.82
H-Index - 87
eISSN - 2042-3306
pISSN - 0425-1644
DOI - 10.1111/evj.12815
Subject(s) - medicine , asthma , corticosteroid , publication bias , meta analysis
Summary Background There are limited findings from low‐powered studies based on few number of subjects with equine asthma. Furthermore, no studies have been performed to assess a meaningful clinically detectable impact of corticosteroids in equine asthma. Objectives To assess and compare the clinical effect of inhaled and systemic corticosteroids in equine asthma and identify a quantitative clinical score suitable to assess the Minimal Important Difference ( MID ), expressed as the Minimally Clinically Detectable Difference ( MCDD ). Study design Pair‐wise and network meta‐analysis. Methods Literature searches for studies on corticosteroid therapy in equine asthma were performed. The risk of publication bias was assessed by Funnel plots and Egger's test. The effect on changes in clinical scores vs. control was analysed via random‐effects models and Bayesian networks. Results Corticosteroids significantly improved the clinical condition (Standardised Mean Difference: −1.52, 95% CrI −2.07 to −0.98; P<0.001 vs. control). No difference was detected between inhaled and systemic corticosteroids with regard to the changes in clinical scores (Relative Effect: 0.08, 95% CrI −1.45 to 1.32; P = 0.8). An Improved clinically Detectable Equine Asthma Scoring System ( IDEASS ) indicated that corticosteroids improved the clinical condition of asthmatic horses by 30% compared with controls ( IDEASS value: −2.36, 95% CI −3.39 to −1.33; P<0.001). A one‐point change in IDEASS represented the MCDD in equine asthma. Main limitations Moderate quality of evidence for systemic corticosteroids. Conclusions Inhaled corticosteroids are effective in improving the clinical condition of horses with equine asthma and prevent exacerbations. Systemic corticosteroids should be used only in selected cases with symptomatic airway hyperresponsiveness during exacerbation. IDEASS requires further validation but may represent a suitable approach to rank the level of asthma severity and assess the clinical effect of pharmacotherapy in horses with equine asthma.