Clinical Ophthalmology (May 2022)
Safety of Intravenous Methylprednisolone in Refractory and Severe Pediatric Uveitis
Abstract
Hashem H Ghoraba,1 Wataru Matsumiya,1,2 Hassan Khojasteh,1 Amir Akhavanrezayat,1 Irmak Karaca,1 Christopher Or,1 Negin Yavari,1 Sherin Lajevardi,1 Jaclyn Hwang,1 Cigdem Yasar,1 Diana Do,1 Quan Dong Nguyen1 1Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA; 2Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, JapanCorrespondence: Quan Dong Nguyen, Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Suite 200, Palo Alto, CA, USA, Tel +16507257245, Fax +1 6507368232, Email [email protected]: To evaluate the safety of intravenous high-dose pulse methylprednisolone succinate (IVHDM) in the management of severe or refractory non-infectious pediatric uveitis.Methods: 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.Results: 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.Conclusion: 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.Keywords: pediatric uveitis, intravenous methylprednisolone, adverse events
