Czy stosowanie dużych dawek metyloprednizolonu w dożylnych pulsach u chorych z orbitopatią Gravesa jest bezpieczne?

Abstract

High dose intravenous glucocorticoid pulse (i.v. GCS) therapy is a proven approach in patients with active, moderate to severe Graves' orbitopathy (GO) and dysthyroid optic neuropathy (DON). In moderate to severe GO, the European Group on Graves' Orbitopathy (EUGOGO) recommends a 12-week course of intravenous methylprednisolone (i.v. MP) pulse therapy with a cumulative dose of 4.5 g. The response rate of i.v. GCS treatment is significantly higher than oral glucocorticoid (oral GCS) therapy and is associated with fewer adverse events. However, a major concern was raised because of reports of fatal side effects which may be associated with this therapy, especially when single and cumulative doses of methylprednisolone (MP) are higher than recommended. The prevalence and severity of adverse effects during treatment have not been fully described. The aim of this review was to summarise the frequency of major adverse effects of i.v. GCS compared to oral GCS and attempt to propose some practical suggestions as to how to monitor and prevent the development of side effects.

Serum concentrations of HGF and IL-8 in patients with active Graves’ orbitopathy before and after methylprednisolone therapy

“…In the cases of moderate-to-severe GO, intravenous glucocorticoid therapy is the first line treatment [ 25 ]. Therefore, patient selection and treatment risks must be adequately addressed, since available therapies for GO are associated with potentially serious adverse effects [ 27 ]. This is an area where new treatment approaches are greatly needed.…”

The influence of Graves’ orbitopathy treatment with intravenous glucocorticoids on adrenal function

“…Interestingly one patient developed AI at this point of therapy. Other GCS side effects occur also less frequently after IV compared to oral route, which may be a result of the specific action of high GCS doses [12]. Buttgereit et al postulated three "modules" of glucocorticoid effect on cells resulting from different concentrations: i) low concentrations mediate effects via genomic events, ii) medium concentrations bind to cell surface receptors, which activate cross membrane signal transmission for genomic and non-genomic intracellular events, and iii) at very large concentrations steroids dissolve in the cell membrane resulting in greater membrane stability and reduced non-genomic cell function [13,14].…”

Blood Pressure Profile and N-Terminal-proBNP Dynamics in Response to Intravenous Methylprednisolone Pulse Therapy of Severe Graves’ Orbitopathy

“…High dose intravenous (i.v.) glucocorticoid (GC) pulse therapy is an effective immunosuppressive treatment used in various inflammatory and autoimmune diseases [ 1 ]. One of the indications for this treatment is Graves’ orbitopathy (GO).…”

“…However, a major concern was raised given reports of fatal side effects that may be associated with this therapy [ 1 , 3 ]. In a meta-analysis performed by Zang et al, calculated morbidity and mortality rates in patients with GO treated with i.v.…”

“…Therapy with i.v. GCs may be associated with mild, moderate, and severe cardiovascular adverse events including cardiac arrhythmias, pulmonary embolism, myocardial infarction, exacerbation of heart failure, and increased blood pressure (BP) [ 1 , 3 , 5 , 6 ].…”