Risk of persistent growth impairment after alternate-day prednisone treatment in children with cystic fibrosis

Background: It is uncertain whether the growth impairment that occurs in ch ildren during long-term treatment with glucocorticoids persists after the m edication is discontinued and ultimately affects adult height. Methods: We evaluated growth six to seven years after alternate-day treatme nt with prednisone had been discontinued in 224 children 6 to 14 years of a ge with cystic fibrosis who had participated in a multicenter trial of this therapy from 1986 through 1991. Of the children, 151 had been randomly ass igned to receive prednisone (1 or 2 mg per kilogram of body weight) and 73 to receive placebo. We obtained data on growth up to 1997 from the Cystic F ibrosis Foundation Patient Registry and standardized the data to sex- and a ge-specific norms from the National Center for Health Statistics. We used z scores to compare growth patterns among treatment groups. Results: In 1997, 68 percent of the patients were 18 years of age or older. The z scores for height declined during prednisone therapy; catch-up growt h began two years after treatment with prednisone was discontinued. Among t he boys, the z scores for height in those treated with prednisone remained lower than the scores for those who received placebo (P=0.02). The mean hei ghts for boys 18 years of age or older were 4 cm less in the prednisone gro ups than in the placebo group, an equivalent of 13 percentile points (P=0.0 3). Among the girls, differences in height between those who were treated w ith prednisone and those who received placebo were no longer present two to three years after prednisone therapy was discontinued. Conclusions: Among children with cystic fibrosis who have received alternat e-day treatment with prednisone, boys, but not girls, have persistent growt h impairment after treatment is discontinued. (N Engl J Med 2000;342:851-9. ) (C)2000, Massachusetts Medical Society.