Safety of intravenous high-dose pulse methylprednisolone succinate in the management of pediatric uveitis

Abstract

Purpose : In this case series, we aim to evaluate the safety of intravenous high dose pulse methylprednisolone succinate (IVHDM) in the management of different types of severe or refractory non-infectious uveitis in a pediatric population.

Methods : We reviewed all uveitis patients who were 16 years of age or younger and who received IVHDM with a dose of ≥ 500 mg per day (1 to 3 days a month) for at least 3 months during their management at a tertiary care eye hospital between June 2018 and October 2020. Adverse events (AEs) were recorded up to 6 months after the last infusion.

Results : 20 pediatric patients who received IVHDM of dose of 500 mg or higher per day were identified. 6 patients received IVHDM only once and were excluded. The remaining 14 patients received IVHDM for at least 4 months, 1 or 3 consecutive days per month. Age was 11.9 ± 2.4 years and 5/14 were male. Duration of treatment was 12.1 ± 6.2 months. 13 patients received IVHDM in combination with other immunomodulatory therapy (IMT). IVHDM was given at a dose of 10-20 mg/kg/infusion. Mean cumulative dose per patient was 17.25 gm (Range: 3.5-50). Concomitant IMT was intravenous infliximab (8/13), tocilizumab (3/13) or immunoglobulins (2/13). Indications for IVHDM were panuveitis with retinal vasculitis (9/14), isolated retinal vasculitis (2/14), autoimmune retinopathy (AIR) (2/14) and juvenile idiopathic arthritis (JIA) associated optic neuritis (1/14).
There were three separate major systemic AEs in three separate patients: asymptomatic sinus bradycardia during infusions, pyogenic arthritis in a patient with a preexisting autoimmune arthritis and a single event of fainting and convulsions. The most common minor systemic AEs were derangements in blood count (10/14), mild increase in random blood glucose (10/14) and transient increase in liver enzymes (8/14). Cataract developed/progressed in 4 patients; 2 of them had been on long-term topical steroids.

Number of AEs was strongly correlated with duration of treatment (coef.:0.799; p<0.001) and moderately correlated with the cumulative dose (coef.:0.572; p=0.033). No statistically significant correlation was found with age of patients.

Conclusions : IVHDM might be a relatively safe therapeutic option for pediatric population with aggressive/refractory posterior or panuveitis. The reported AEs in this series can also be attributed to the concurrent IMT or the underlying disease itself.

This is a 2021 ARVO Annual Meeting abstract.