https://wikem.org/w/index.php?action=history&feed=atom&title=EBQ%3ATOAST_Trial 2026-04-17T19:33:10Z Revision history for this page on the wiki MediaWiki 1.38.2 https://wikem.org/w/index.php?title=EBQ:TOAST_Trial&diff=150035&oldid=prev 2017-08-04T14:35:22Z

<p>Effectiveness of Dexamethasone in symptom management of Acute pharyngitis</p> <p><b>New page</b></p><div>{{JC info<br /> | title=Effect of Oral Dexamethasone Without Immediate Antibiotics vs Placebo on Acute Sore Throat in Adults: A Randomized Clinical Trial.<br /> | abbreviation=TOAST Trial<br /> | expansion=<br /> | published=2017<br /> | author=Hayward GN, Hay AD, Moore MV, Jawad S, Williams N, Voysey M, Cook J, Allen J, Thompson M, Little P, Perera R, Wolstenholme J, Harman K, Heneghan C<br /> | journal=JAMA<br /> | year=2017<br /> | volume=317<br /> | issue=15<br /> | pages= 1535-1543<br /> | pmid=28418482 <br /> | fulltexturl= https://www.ncbi.nlm.nih.gov/pubmed/28418482<br /> | pdfurl=<br /> | status=Complete<br /> }}<br /> ==Clinical Question==<br /> *Does the use of oral dexamethasone in acute pharyngitis in the absence of antibiotics significantly increase the rate of resolution of symptoms at 24 hours?<br /> <br /> ==Conclusion==<br /> *The use of single dose oral dexamethasone compared with placebo did not increase the proportion of patients with resolution of symptoms at 24 hours. However, there was a significant difference at 48 hours<br /> <br /> ==Major Points== <br /> *Corticosteroids may be beneficial in the treatment of acute pharyngitis as they are in upper respiratory infections but the effect is likely more pronounced in those with severe symptoms.<br /> <br /> ==Study Design==<br /> *Multicenter, double-blinded, placebo-controlled, parallel group randomized trial<br /> *England, 42 family practice centers<br /> *576 adult patients with acute pharyngitis, not require antibiotics<br /> *study group given single dose of 10mg dexamethasone or placebo. <br /> <br /> ==Population==<br /> ===Inclusion Criteria===<br /> *≥18 years of age<br /> *Sore throat/odynophagia thought to be inefective in origin<br /> *Symptom onset in the last 7 days<br /> *No need for antibiotic treatment<br /> *Consent to participate and willingness to keep a symptom journal.<br /> <br /> ===Exclusion Criteria===<br /> *Pregnant/breast feeding<br /> *Use of inhaled or oral corticosteroids within the last month<br /> *History of tonsillectomy in the last month<br /> *Use of antibiotics in the last 14 days<br /> *Alternative Diagnosis<br /> *Immunodeficiency<br /> *Hospital admission<br /> *Antibiotics needed<br /> *Allergy to dexamethasone<br /> <br /> ==Interventions== <br /> *10mg oral dexamethasone or identical placebo<br /> <br /> ==Outcomes==<br /> *565 patients were eligible<br /> **288 given dexamethason<br /> **277 given placebo<br /> *Median Age of 34<br /> *75.2% women<br /> *100% completed intervention<br /> <br /> ===Primary Outcome===<br /> *Proportion of patients experiencing complete resolutino of symptoms at 24 hours<br /> **Dexamethasone 22.6%<br /> **Placebo 17.7%<br /> **Risk Difference (95% C.I.) 4.7% (-1.8-11.2)<br /> **RR (95% CI): 1.28 (0.92-1.78)<br /> **P value 0.14<br /> <br /> ===Secondary Outcomes=== <br /> *Complete Resolution in 48 hours<br /> **35.4% Dexamethasone<br /> **27.1% Placebo<br /> **Risk Difference 8.7% (1.2-16.2)<br /> **RR 1.31 (1.02-1.68)<br /> **P Value 0.03<br /> *Duration of moderately bad symptoms (Based on Likert scale)<br /> *Visual analog scales<br /> *Health care attendance<br /> <br /> '''No statistical difference in the remainder of secondary outcomes'''<br /> <br /> ==Criticisms &amp; Further Discussion==<br /> ===Strengths===<br /> *Multicenter, double-blind, placebo-controlled, parallel group randomized trial<br /> *Sample size large enough to find 18% increase in resolution with 90% power<br /> *Primary outcome was collected from 93.6% of participants<br /> <br /> ===Limitations===<br /> *Excluding patients receiving antibiotics may have excluded a population that would have benefited more from treatment<br /> *No children were studied<br /> *Primary outcome was not well validated<br /> *Study unable to detect difference less than 18% due to underpower<br /> <br /> ===Discussion===<br /> *Although there was no difference in primary outcome, there was significant difference at 48 hours. <br /> **Gives a NNT of 12<br /> *The study was underpowered to detect differences less than 18%<br /> **A larger study could potentially find a more significant difference<br /> *Patients may not have had symptoms severe enough to benefit from treatment<br /> **Patients who needed antibiotics were excluded<br /> **Generally speaker, sicker patients, would likely benefit more from dexamethasone treatment<br /> ***Other studies have supported this in the past<br /> *Study was done at family care centers<br /> **Potentially the patient population may not represent what is seen in the ED as their symptoms may not have been as &quot;severe&quot; or emergent. <br /> <br /> ==External Links==<br /> [http://www.isrctn.com/ISRCTN17435450 ISRCTN Registry]<br /> <br /> ==See Also==<br /> <br /> ==Funding==<br /> *National Institute for Health Research (UK)<br /> <br /> ==References==<br /> &lt;references/&gt;<br /> <br /> [[Category:EBQ]]</div>

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