Deflazacort is an oxazoline derivative of
prednisolone with anti-inflammatory and immunosuppressive activity. Both short (4 to 6 weeks) and longer term (13 to 52 weeks) studies have shown
deflazacort to be as effective as
prednisone or
methylprednisolone in patients with
rheumatoid arthritis. The
drug was at least as effective as
prednisone in children with
juvenile chronic arthritis. Insufficient data are available to draw firm conclusions regarding the efficacy of
deflazacort as treatment for patients with severe
asthma, but the
drug has demonstrated some efficacy as treatment for
nephrotic syndrome and other applications such as Duchenne dystrophy,
systemic lupus erythematosus,
uveitis and
transplantation. The overall incidence of adverse events in
deflazacort recipients (16.5%) is lower than that recorded in patients treated with
prednisone (20.5%) or
methylprednisolone (32.7%) and similar to that in
betamethasone recipients (15.3%). Gastrointestinal symptoms are the most frequently reported adverse events in
deflazacort recipients; other adverse events associated with the
drug include metabolic and
nutritional disorders, central and peripheral nervous system disturbances and
psychiatric disorders. In general,
deflazacort appears to have less effect than
prednisone on parameters which may be associated with the development of
corticosteroid-induced
osteoporosis. Further, the
drug appears have less negative impact on growth rate in children with diseases requiring
corticosteroid therapy. In a study of 2 months' duration in patients with conditions requiring
corticosteroid treatment, moderate dosages of
deflazacort produced no clinically relevant diabetogenic effects. Thus,
deflazacort may be associated with less serious metabolic sequelae than
prednisone but further well designed long term trials are required to confirm this. In the meantime, in adults,
deflazacort should be reserved for use in those pre-disposed to, or who develop, intolerable metabolic sequelae during treatment with
corticosteroids. In children, however, even though available efficacy data are minimal,
deflazacort should be considered as an initial option in those requiring
corticosteroid therapy since the adverse effects caused by this
drug class are particularly debilitating in this patient group.