Safety Profile and Effects of Pulsed Methylprednisolone on Vital Signs in Thyroid Eye Disease

Abstract

Objective. To analyze changes in vital signs (heart rate (HR), systolic (SBP), and diastolic blood pressure (DBP)) during and after intravenous methylprednisolone (IVMP) and any other adverse effects. Methods. Retrospective review of charts of patients who received IVMP as treatment regime for thyroid eye disease. All subjects had vital signs charted during and after infusions. Results. This study included 38 subjects and a total of 242 infusions administered. IVMP resulted in a small but significant percentage drop in mean SBP at 30 min (p < 0.001) and 60 min (p = 0.03) but no difference at 90 min. There was also small but significant percentage drop in mean DBP and HR (DBP: p < 0.001 for 30 min, p = 0.001 for 60 min, and p = 0.02 for 90 min and HR: p < 0.001 for 30 min, 60 min, and 90 min). There were no cumulative effects on change of blood pressure or HR. There were 6 episodes of bradycardia (2.5%) and 12 episodes of moderate to severe hypertension (5%). No significant cardiovascular or hepatic toxicity was found. Conclusion. IVMP is relatively safe and efficacious. IVMP demonstrated mild and noncumulative effects on vital signs. Severe hypertension may occur in susceptible individuals such as those with underlying hypertension and uncontrolled thyroid dysfunction, whereas bradycardia may be more likely in those on beta-blockers.

A rare case of drug‐induced bradycardia associated with the just low dose use of methylprednisolone in a child with COVID‐19

“…4 As is reported, no serious adverse effect such as bradycardia was found in arbidol treatment so far, 5,6 but in fact, a previous study showed that a high dosage of corticosteroids could cause sinus bradycardia. 7 However, in our case, the patient with COVID-19 manifests sinus bradycardia with the use of just a low dosage MP of 0.58 mg/kg/day, whereas the heart rate came back to normal level upon cessation of MP and arbidol.…”

“…As is known, although viral myocarditis may induce a variety of slow cardiac arrhythmia as a result of a direct or indirect myocardial injury caused by SARS‐CoV‐2, the diagnosis proof of suspected myocarditis is ruled out on account of the several negative results of myocardial injury marker and echocardiograph according to the diagnostic criteria for clinically suspected myocarditis 4 . As is reported, no serious adverse effect such as bradycardia was found in arbidol treatment so far, 5,6 but in fact, a previous study showed that a high dosage of corticosteroids could cause sinus bradycardia 7 . However, in our case, the patient with COVID‐19 manifests sinus bradycardia with the use of just a low dosage MP of 0.58 mg/kg/day, whereas the heart rate came back to normal level upon cessation of MP and arbidol.…”

Timing methylprednisolone pulse therapy in COVID-19 infection-finding the sweet spot: a case series

“…The apoptotic doses of pulse therapy though beneficial in various clinical conditions also conferred significant risk in terms of acute liver failure, cerebrovascular or cardiovascular effects. 10 It was therefore extremely important that patient selection should be such that it took into account this risk-benefit ratio. In our case series patients that were given pulse IV methyl prednisolone doses were all relatively young with a mean age of 40 years.…”

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

“…This is the first study suggesting the potential cumulative effect of IVMP administration on the circadian BP profile. The fast reaction of BP to IVMP pulses was analysed in a retrospective study by Yong et al (1.0 g of IVMP) [ 10 ] and a prospective study by Lauridsen et al (0.5 g of IVMP) [ 13 ]. There was an observed decrease in SBP and DBP at 30 and 60 min after an IVMP pulse in the first study and no change in SBP with a reduction in DBP 90 min after an IVMP pulse in the second study.…”

“…A consensus on the monitoring of patients during and after IVMP pulse administration has not yet been established [ 2 , 10 ]. The effects of IVMP treatment on hemodynamic markers have not yet studied in detail.…”