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Hashem Ghoraba, Amir Akhavanrezayat, Wataru Matsumiya, Brandon Pham, Cigdem Yasar, Irmak Karaca, Azadeh Mobasserian, Jonathan Regenold, Brandon Chau Lam, Jacklyn Joyce Hwang, Sherin Lajevardi, Negin Yavari, Muhammad Sohail Halim, Yasir J Sepah, Diana V Do, Quan Dong Nguyen; Safety of intravenous high-dose pulse methylprednisolone succinate in the management of pediatric uveitis. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1418.
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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.
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.
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.
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.
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