Clinical Experience of Use of High‐dose Intravenous Methylprednisolone in Children With Acute Moderate to Severe Colitis

Abstract

Our data show that in paediatric ASC, the short-term use of high-dose IVCS is safe and effective. Prospective studies are needed to define the role of IVCS within salvage therapy protocols.

Management of Paediatric Ulcerative Colitis, Part 2

“…Nonetheless, some case series suggested a benefit to higher and even pulse doses (161)(162)(163) while others did not (164,165). It could be concluded that the vast majority of evidence suggests that 40 mg is not less effective than higher doses in ASC but, given the few anecdotal reports and the severity of ASC, it is not unreasonable to dose higher in selected patients for several days until response has been achieved.…”

“…Higher doses were also not justified according to a recent propensity score analysis in a large pediatric cohort of ASC (including among others the children from the OSCI study) (160) and, in a retrospective study among children with ASC, the dose of corticosteroids within the standard range was not different between those who responded and those who failed IVCS (9). Nonetheless, some case series suggested a benefit to higher and even pulse doses (161)(162)(163) while others did not (164,165). It could be concluded that the majority of evidence suggests that 40 mg is not less effective than higher doses in ASC but, given the few anecdotal reports and the severity of ASC, it is not unreasonable to dose higher in selected patients for several days until response has been achieved.…”

Improved Medical Treatment and Surgical Surveillance of Children and Adolescents with Ulcerative Colitis in the United Kingdom

“…Notably, an alternative treatment for successful treatment of ASC published recently by the Liverpool centre, was applied in 5% (15/298) of children admitted in this audit (24). Based on a short-term course of high dose (20mg/kg) iv methylprednisolone, with this protocol the steroid dependency rate had been reported before as 21% after 6 months and 0% after 1 year (24).…”

Steroid Limbo in Acute Severe Ulcerative Colitis

“…(8) With equivalence now shown down to a median dose of 0.8mg/kg in the work of Choshen, et al at least for PUCAI scores and second-line therapy, we wonder how low doses could go whilst retaining the most important outcome measure of avoiding colectomy in this challenging condition? Steroid therapy has been a mainstay in ulcerative colitis management for more than sixty years since the landmark placebo control trial of Truelove and Witts.…”

“…(8) The centre in question was also the one that caused some challenging high dose results in the Choshen paper, so a further expansion and Copyright © ESPGHAN and NASPGHAN. All rights reserved.…”