Safety of Intravenous Methylprednisolone in Refractory and Severe Pediatric Uveitis.
Safety of Intravenous Methylprednisolone in Refractory and Severe Pediatric Uveitis.
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DOI：
10.2147/opth.s366370
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发表时间：
2022
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评价静脉注射大剂量脉冲琥珀酸甲基强的松龙（IVHDM）治疗严重或难治性非感染性儿童葡萄膜炎的安全性。我们回顾了所有≤16岁且在三级眼科医院接受IVHDM治疗至少3个月期间每天（每月1-3天）剂量≥500mg的葡萄膜炎患者。我们确定了20例接受IVHDM治疗的严重或难治性葡萄膜炎患儿。6例患者接受了IVHDM一次，作为术前用药，或剂量低于500mg，并被排除在外。其余14例患者接受IVHDM治疗至少4个月。年龄（mean±SD） 11.9±2.4岁，女性占50%。治疗时间14.2±7.5个月。13例患者接受IVHDM联合其他免疫调节治疗（IMT）。除两个异常值外，IVHDM的剂量为每次输注8 - 25mg /kg。2例患者发生了3个主要不良事件：单次心动过缓、轻微外伤后压缩性骨折和肾上腺功能不全。不良反应（严重和轻微）的数量与治疗时间密切相关（p=0.004），与累积剂量/体重适度相关（p=0.051）。体重增加与同时使用口服类固醇有关，而与治疗时间或累积剂量无关。IVHDM可能是侵袭性/难治性儿童葡萄膜炎的有效治疗选择。本系列报道的ae也可归因于并发IMT或潜在疾病本身。
To evaluate the safety of intravenous high-dose pulse methylprednisolone succinate (IVHDM) in the management of severe or refractory non-infectious pediatric uveitis. We reviewed all uveitis patients who were ≤16 years of age and who received IVHDM with a dose of ≥500 mg per day (1–3 days a month) for at least 3 months during their management at a tertiary care eye hospital. Twenty pediatric patients with severe or refractory uveitis who received IVHDM were identified. Six patients received IVHDM either once, as a preoperative medication, or at a lower dose than 500 mg, and were excluded. The remaining 14 patients received IVHDM for at least 4 months. Age (mean±SD) was 11.9±2.4 years and 50% were female. Duration of treatment was 14.2±7.5 months. Thirteen patients received IVHDM in combination with other immunomodulatory therapy (IMT). Except for two outliers, IVHDM was given at a dose of 8–25 mg/kg per infusion. Three major adverse events (AEs) occurred in two patients: a single episode of bradycardia, compression fracture following minor trauma and adrenal insufficiency. The number of AEs (major and minor) strongly correlated with duration of treatment (p=0.004) and moderately correlated with the cumulative dose/weight (p=0.051). Weight gain was associated with the use of concomitant oral steroids and not with duration of treatment or cumulative dose. IVHDM may be a valid therapeutic option for aggressive/refractory pediatric uveitis. The reported AEs in this series can also be attributed to the concurrent IMT or the underlying disease itself.