Effects of deflazacort versus prednisone on bone mass, body composition, and lipid profile : A randomized, double blind study in kidney transplant patients

• Published in: The journal of clinical endocrinology and metabolism Vol. 83; no. 11; pp. 3795 - 3802
• Main Authors: LIPPUNER, K, CASEZ, J.-P, HORBER, F. F, JAEGER, P
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Endocrine Society 01.11.1998
• Subjects: Biological and medical sciences; Body Composition - drug effects; Bone Density - drug effects; Carbohydrate Metabolism; Double-Blind Method; Female; Glucocorticoids - adverse effects; Humans; Immunomodulators; Immunosuppressive Agents - adverse effects; Kidney Transplantation - adverse effects; Lipid Metabolism; Lumbosacral Region; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Prednisone - adverse effects; Pregnenediones - adverse effects; Prospective Studies; Switzerland; Europe; Human; Corticosteroid; Deflazacort; Treatment efficiency; Prednisone; Transplantation; Density; Body composition; Kidney; Chemotherapy; Lipemia; Bone mass; Treatment; Mineral bone; Surgery; Double blind study; Adult; Immunosuppressive agent
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.83.11.3795

To compare the effects of deflazacort (DEFLA) vs. prednisone (PRED) on bone mineral density (BMD), body composition, and lipids, 24 patients with end-stage renal disease were randomized in a double blind design and followed 78 weeks after kidney transplantation. BMD and body composition were assessed using dual energy x-ray absorptiometry. Seventeen patients completed the study. Glucocorticosteroid doses, cyclosporine levels, rejection episodes, and drop-out rates were similar in both groups. Lumbar BMD decreased more in PRED than in DEFLA (P < 0.05), the difference being particularly marked after 24 weeks (9.1 +/- 1.8% vs. 3.0 +/- 2.4%, respectively). Hip BMD decreased from baseline in both groups (P < 0.01), without intergroup differences. Whole body BMD decreased from baseline in PRED (P < 0.001), but not in DEFLA. Lean body mass decreased by approximately 2.5 kg in both groups after 6-12 weeks (P < 0.001), then remained stable. Fat mass increased more (P < 0.01) in PRED than in DEFLA (7.1 +/- 1.8 vs. 3.5 +/- 1.4 kg). Larger increases in total cholesterol (P < 0.03), low density lipoprotein cholesterol (P < 0.01), lipoprotein B2 (P < 0.03), and triglycerides (P = 0.054) were observed in PRED than in DEFLA. In conclusion, using DEFLA instead of PRED in kidney transplant patients is associated with decreased loss of total skeleton and lumbar spine BMD, but does not alter bone loss at the upper femur. DEFLA also helps to prevent fat accumulation and worsening of the lipid profile.