What is the use of mometasone (a topical corticosteroid) in pediatric patients?

From the Guidelines

Mometasone can be used in children for certain conditions, such as atopic dermatitis, under a doctor's supervision, with careful consideration of potential side effects and growth suppression. For children with atopic dermatitis, mometasone can be used as a topical corticosteroid, with a potency classified as medium, and is usually applied once or twice daily until the lesions are significantly improved 1. Some key points to consider when using mometasone in children include:

• Mometasone can be used proactively with twice-weekly application to previously affected skin areas for up to 16 weeks to prevent relapses in children with moderate to severe atopic dermatitis 1.
• High potency topical corticosteroids, including mometasone, should be used with caution in highly sensitive skin areas, such as the face, neck, and skin folds, to avoid skin atrophy 1.
• Infants and young children with atopic dermatitis should be treated with less potent topical corticosteroids due to an increased risk of adrenal suppression from potent corticosteroids 1.
• Long-term use of mometasone requires monitoring, as corticosteroids can potentially affect growth in children, although studies have shown no effects on growth compared to placebo at recommended doses 1. It is essential for parents to follow the prescribed dosage, complete the full treatment course, and discuss any concerns with their child's healthcare provider.

From the FDA Drug Label

ASMANEX TWISTHALER is an inhaled corticosteroid (ICS) prescription medicine used as maintenance treatment for the prevention and control of asthma symptoms in people 4 years of age and older. It is not known if ASMANEX TWISTHALER is safe and effective in children less than 4 years of age. Patients should be informed that orally inhaled corticosteroids, including mometasone furoate inhalation powder, may cause a reduction in growth velocity when administered to pediatric patients. Physicians should closely follow the growth of children and adolescents taking corticosteroids by any route [see Warnings and Precautions (5. 8)].

Mometasone for children:

• Mometasone is approved for use in children 4 years of age and older for the prevention and control of asthma symptoms.
• The safety and effectiveness of mometasone in children less than 4 years of age is not known.
• Reduced growth velocity is a potential risk in pediatric patients taking mometasone, and physicians should closely monitor the growth of children and adolescents taking this medication 2.

From the Research

Mometasone for Children

• Mometasone furoate is a synthetic corticosteroid that has been evaluated for intranasal use in the treatment of adults and children with allergic rhinitis 3.
• Studies have shown that mometasone furoate nasal spray (MFNS) is safe and effective for the treatment of allergic rhinitis in children, with a significant reduction in symptom scores compared to placebo 4, 5, 6.
• The recommended dose of MFNS for children is 100 microg once daily, which has been shown to be effective in reducing total nasal symptom scores (TNSS) and total symptom scores (TSS) 4, 5.
• MFNS has been well-tolerated in children, with the most common adverse events being epistaxis, headache, and pharyngitis 4, 5, 6.
• Long-term safety studies have shown that MFNS is safe for use in children for up to 1 year, with no significant changes in intraocular pressure or suppression of the hypothalamic-pituitary-adrenal axis 6.
• The safety of MFNS in children has also been reviewed in a safety update, which concluded that the newer formulations of topical corticosteroids, such as mometasone furoate, may be safer for long-term use due to their lower systemic bioavailability 7.

Efficacy of Mometasone in Children

• MFNS has been shown to be effective in reducing TNSS and TSS in children with perennial allergic rhinitis, with a significant reduction in symptom scores compared to placebo 5.
• MFNS has also been shown to be effective in reducing individual nasal symptom scores, such as sneezing, runny nose, and nasal congestion 5.
• The efficacy of MFNS in children has been demonstrated in several studies, including a 4-week efficacy and safety study and a 6-month open-label safety study 4, 5.

Safety Considerations

• The most common adverse events associated with MFNS in children are epistaxis, headache, and pharyngitis 4, 5, 6.
• Long-term safety studies have shown that MFNS is safe for use in children for up to 1 year, with no significant changes in intraocular pressure or suppression of the hypothalamic-pituitary-adrenal axis 6.
• The safety of MFNS in children has also been reviewed in a safety update, which concluded that the newer formulations of topical corticosteroids, such as mometasone furoate, may be safer for long-term use due to their lower systemic bioavailability 7.