Five double-blind RCTs (4 beclomethasone, 1 fluticasone) including 855 participants.
Some of the findings relating to beclomethasone have been published as a Cochrane Review (see Other Publications of Related Interest no.2).
Mean linear growth velocity (fixed-effect model, random-effects model not reported):
1. Beclomethasone (328-400 micrograms/day).
All trials (n=4 studies): WMD=-1.51cm/yr (95% CI: -1.159, -1.87).
Quality score >/=4 (n=3 studies): WMD=-1.65cm/yr (95% CI: -1.23, -2.06).
Quality score <=4 (n=1 study): WMD=-1.08cm/yr (95% CI: -0.35, -1.81).
Concealment adequate (n=3 studies): WMD=-1.65cm/yr (95% CI: -1.23, -2.06).
Concealment not adequate (n=1 study): WMD=-1.08cm/yr (95% CI: -0.35, -1.81).
Delivery method - diskhaler (n=3 studies): WMD=-1.54cm/yr (-1.15, -1.94).
Delivery method - metered-dose inhaler (n=1 study): WMD=-1.30cm/yr (95% CI: -0.38, -2.23).
Placebo-controlled (n=2 studies): WMD=-1.57cm/yr (95% CI: -1.15, -1.99).
Theophylline/salmeterol controlled (n=2 studies): WMD=-1.35cm/yr (95% CI: -0.66, -2.03).
2. Fluticasone (200 micrograms/day).
All trials (n=1 study): Mean difference=-0.43cm/yr (95% CI: -0.01, -0.85).
Heterogeneity:
Across all five studies the Q test produced a z value of 7.52 and a P value of >0.999, which revealed no evidence of significant heterogeneity between studies.
Quality of studies:
The mean Jadad score was 4.0 (SD=0.71) out of a possible maximum 5 points. Four of the five trials reported an adequate method of randomisation using an independent randomisation centre. Compliance was evaluated in four out of the five studies, withdrawal rates were low (10-33%) and each study adequately addressed the reasons for drop-out.
Publication bias:
A funnel plot of the four beclomethasone studies revealed no obvious exclusion of studies concluding a small measure of effect, although this should be viewed with caution considering the small number of studies and hence low power of the assessment.