What is the recommended dose of deflazacort for asthma management?

Deflazacort Dosing for Asthma

Deflazacort at 1.5 mg/kg/day orally for 7 days is effective for moderate acute asthma exacerbations in children, showing equivalent efficacy to prednisolone 1 mg/kg/day. 1

Evidence-Based Dosing Recommendations

Pediatric Dosing (Ages 6-14 years)

• Deflazacort 1.5 mg/kg orally once daily for 7 days is the established dose for moderate acute asthma exacerbations in children, demonstrating comparable improvements in FEV1, peak expiratory flow, and symptom scores to standard prednisolone therapy 1
• This dosing achieved significant clinical improvement by day 2, with continued improvement through day 7 without adverse effects 1
• The dose equivalency ratio is approximately 1.5:1 (deflazacort:prednisolone), meaning deflazacort requires a 50% higher milligram dose to achieve equivalent therapeutic effect 1

Adult Dosing (Extrapolated from Equivalency Data)

• Based on the established prednisolone dose of 30-60 mg daily for adults with acute asthma exacerbations 2, the equivalent deflazacort dose would be 45-90 mg daily using the 1.5:1 conversion ratio 3, 1
• Standard adult prednisolone dosing is 40-60 mg daily until peak expiratory flow reaches 70% of predicted 2, suggesting deflazacort 60-90 mg daily would be the appropriate equivalent dose

Clinical Algorithm for Deflazacort Use

When to Consider Deflazacort

• Reserve deflazacort for patients at high risk of corticosteroid-induced metabolic complications, particularly osteoporosis, growth suppression in children, or diabetogenic effects 4
• Deflazacort demonstrates less negative impact on bone metabolism and growth parameters compared to prednisone, making it particularly valuable in pediatric populations requiring prolonged corticosteroid therapy 4
• In children requiring corticosteroid therapy, deflazacort should be considered as an initial option due to its more favorable adverse effect profile in this vulnerable population 4

Treatment Duration

• Continue for 7 days for moderate exacerbations based on the pediatric trial evidence 1
• For standard acute exacerbations, 5-10 days is the typical course duration, with no tapering required for courses less than 7-10 days, especially if concurrent inhaled corticosteroids are used 2

Important Clinical Considerations

Relative Potency and Conversion

• Deflazacort has approximately 66-70% of the potency of prednisolone on a milligram-per-milligram basis, requiring dose adjustment when converting between agents 3, 1
• The therapeutic index of deflazacort appears favorable, with lower overall adverse event incidence (16.5%) compared to prednisone (20.5%) or methylprednisolone (32.7%) 4

Concurrent Therapy Requirements

• Always combine with high-dose inhaled beta-agonists (salbutamol 5 mg or terbutaline 10 mg nebulized) regardless of which systemic corticosteroid is chosen 5, 2
• Continue inhaled corticosteroids at appropriate maintenance doses throughout and after the acute exacerbation 2

Monitoring Response

• Measure peak expiratory flow 15-30 minutes after starting treatment and continue monitoring according to response 5, 2
• Treatment goal is to achieve peak expiratory flow ≥70% of predicted or personal best 2

Critical Pitfalls to Avoid

• Do not use deflazacort as first-line therapy for acute asthma exacerbations unless specific contraindications to standard corticosteroids exist, as prednisolone/prednisone remains the evidence-based standard with more robust clinical trial data 2
• Do not underdose deflazacort by using prednisolone-equivalent milligram amounts—remember the 1.5:1 conversion ratio is essential 1
• Avoid unnecessarily prolonged courses beyond 7-10 days without reassessing clinical response and peak flow measurements 2
• The evidence for deflazacort in severe asthma is insufficient to draw firm conclusions, so reserve its use for moderate exacerbations or specific patient populations with metabolic concerns 4