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Does Low-Dose Intravenous Methylprednisolone Pulse Therapy Produce Unacceptable Adverse Effects in Children?

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DOI: 10.4236/ojneph.2013.34033    3,443 Downloads   5,802 Views  

ABSTRACT

Background: Intravenous methylprednisolone pulse therapy has been used since the late 1960s for acute transplant rejection or severe renal involvement in systemic lupus erythematosus and primary glomerulonephritis. However, reports of serious adverse effects such as life-threatening cardiac arrhythmias and sudden death raise questions about its safety. Objective: To investigate the incidence of significant adverse effects associated with low-dose methylprednisolone pulse therapy (LDMPT) in pediatric patients. Methods: We retrospectively analyzed adverse effects during and after LDMPT in 68 patients (median age: 11.4 years; 43% male) with various glomerular diseases who were admitted to Saitama Childrens Medical Center between April 2007 and December 2010. LDMPT consisted of pulse methylprednisolone (15-20 mg/kg; maximum 600 mg/d) for 3 consecutive days weekly for 2-3 weeks. Results: Although adverse effects occurred in 54 of 68 patients (79%), most were mild and transient. Transient glycosuria was noted in 46 patients (68%), hypertension in 6 (9%), elevated intraocular pressure in 6 (9%), hypokalemia in 5 (7%), and liver damage in 2 (3%). No late-onset adverse effects such as osteoporotic fractures, steroid diabetes mellitus, or short stature were observed. Conclusion: LDMPT appears to be relatively safe and well tolerated in children with various glomerular diseases.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

D. Hirano, S. Fujinaga, A. Endo, T. Watanabe and H. Ida, "Does Low-Dose Intravenous Methylprednisolone Pulse Therapy Produce Unacceptable Adverse Effects in Children?," Open Journal of Nephrology, Vol. 3 No. 4, 2013, pp. 189-193. doi: 10.4236/ojneph.2013.34033.

References

[1] E. S. Cathcart, B. A. Idelson, M. A. Scheinberg and W. G. Couser, “Beneficial Effects of Methylprednisolone ‘Pulse’ Therapy in Diffuse Proliferative Lupus Nephritis,” The Lancet, Vol. 307, No. 7952, 1976, pp. 163-166.
http://dx.doi.org/10.1016/S0140-6736(76)91272-1
[2] R. J. Levinsky, J. S. Cameron and J. F. Soothill, “Serum Immune Complexes and Disease Activity in Lupus Nephritis,” The Lancet, Vol. 309, No. 8011, 1977, pp. 564-567. http://dx.doi.org/10.1016/S0140-6736(77)91998-5
[3] A. Sinha and A. Bagg, “Pulse Steroid Therapy,” The Indian Journal of Pediatrics, Vol. 75, No. 10, 2008, pp. 1057-1066. http://dx.doi.org/10.1007/s12098-008-0210-7
[4] M. Ohya, H. Otani, Y. Minami, S. Yamanaka, T. Mima, S. Negi, S. Yukawa and T. Shigematsu, “Tonsillectomy with Steroid Pulse Therapy Has More Effect on the Relapse Rate than Steroid Pulse Monotherapy in IgA Nephropathy Patients,” Clinical Nephrology, Vol. 80, No. 1, 2013, pp. 47-52. http://dx.doi.org/10.5414/CN107861
[5] D. Gracey, R. Garsia, W. Britton and P. McKenzie. “Rapid Recovery of Renal Function after Pulse Steroid Therapy in a Human Immunodeficiency Virus-Infected Patient with Glomerulonephritis,” Internal Medicine Journal, Vol. 42, No. 12, 2012, pp. 1363-1365.
http://dx.doi.org/10.1111/imj.12014
[6] B. L. Erstad, “Severe Cardiovascular Adverse Effects in Association with Acute, High-Dose Corticosteroid Administration,” Drug Intelligence and Clinical Pharmacy, Vol. 23, No. 12, 1989, pp. 1019-1023.
[7] B. A. McDougal, F. C. Whittier and D. E. Cross, “Sudden Death after Bolus Steroid Therapy for Acute Rejection,” Transplantation Proceedings, Vol. 8, No. 3, 1976, pp. 493-496.
[8] M. S. Klein-Gitelman and L. M. Pachman, “Intravenous Corticosteroids: Adverse Reactions Are More Variable than Expected in Children,” The Journal of Rheumatology, Vol. 25, No. 10, 1998, pp. 1995-2002.
[9] “The Boston Collaborative Drug Surveillance Program. Acute Adverse Reactions to Prednisone in Relation to Dosage,” Clinical Pharmacology & Therapeutics, Vol. 13, No. 5, 1972, pp. 694-698.
[10] M. D. Smith, M. J. Ahern and P. J. Roberts-Thomson, “Pulse Methylprednisolone Therapy in Rheumatoid Arthritis: Unproved Therapy, Unjustified Therapy, or Effective Adjunctive Treatment?” Annals of the Rheumatic Diseases, Vol. 49, No. 4, 1990, pp. 265-267.
http://dx.doi.org/10.1136/ard.49.4.265
[11] B. A. Baethge, M. D. Lidsky and J. W. Goldber, “A Study of Adverse Effects of High-Dose Intravenous (Pulse) Methylprednisolone Therapy in Patients with Rheumatic Disease,” Annals of Pharmacotherapy, Vol. 25, No. 3, 1992, pp. 316-320.
[12] R. Garrett and H. Paulus, “Complications of Intravenous Methylprednisolone Pulse Therapy (Abstract),” Arthritis & Rheumatism, Vol. 23, No. 6, 1980, p. 677.
[13] S. Fujimoto, H. Kondoh, Y. Yamamoto, S. Hisanaga and K. Tanaka, “Holter Electrocardiogram Monitoring in Nephrotic Patients during Methylprednisolone Pulse Therapy,” American Journal of Nephrology, Vol. 10, No. 3, 1990, pp. 231-236. http://dx.doi.org/10.1159/000168087
[14] C. Svorcík and L. Bicíková, “Effect of Drugs on the Stimulation Threshold of the Human Heart,” Cor et Vasa, Vol. 20, No. 3, 1978, pp. 184-195.
[15] G. Pagano, P. Cavallo-Perin, M. Cassader, A. Bruno, A. Ozzello, P. Masciola, A. M. Dall’omo and B. Imbimbo, “An in Vivo and in Vitro Study of the Mechanism of Prednisone-Induced Insulin Resistance in Healthy Subjects,” The Journal of Clinical Investigation, Vol. 72, No. 5, 1983, pp. 1814-1820.
http://dx.doi.org/10.1172/JCI111141
[16] M. McMahon, J. Gerich and R. Rizza, “Effects of Glucocorticoids on Carbohydrate Metabolism,” Diabetes/Metabolism Reviews, Vol. 4, No. 1, 1988, pp. 17-30.
http://dx.doi.org/10.1002/dmr.5610040105
[17] M. K. Pandit, J. Burke, A. B. Gustafson, A. Minocha and A. N. Peiris, “Drug-Induced Disorders of Glucose Tolerance,” Annals of Internal Medicine, Vol. 118, No. 7, 1993, pp. 529-539.
http://dx.doi.org/10.7326/0003-4819-118-7-199304010-00008
[18] J. H. Gurwitz, R. L. Bohn, R. J. Glynn, M. Monane, H. Mogun and J. Avorn, “Glucocorticoids and the Risk for Initiation of Hypoglycemic Therap,” Archives of Internal Medicine, Vol. 154, No. 1, 1994, pp. 97-101.
http://dx.doi.org/10.1001/archinte.1994.00420010131015
[19] S. Feldman-Billard, B. Lissak, R. Benrabah, R. Kassaei and E. Héron, “Intravenous Pulse Methylprednisolone Therapy in Eye Disease,” Ophthalmology, Vol. 110, No. 12, 2003, pp. 2369-2371.
http://dx.doi.org/10.1016/S0161-6420(03)00818-2
[20] A. Zonana-Nacach, S. G. Barr, L. S. Magder and M. Petri, “Damage in Systemic Lupus Erythematosus and Its Association with Corticosteroids,” Arthritis & Rheumatism, Vol. 43, No. 8, 2000, pp. 1801-1808.
http://dx.doi.org/10.1002/1529-0131(200008)43:8<1801::AID-ANR16>3.0.CO;2-O
[21] M. Radia and D. E. Furst, “Comparison of Three Pulse Methylprednisolone Regimens in the Treatment of Rheumatoid Arthritis,” The Journal of Rheumatology, Vol. 15, No. 2, 1998, pp. 242-246.
[22] M. E. Shipley, P. A. Bacon, H. Berry, B. L. Hazleman, R. D. Sturrock, D. R. Swinson and I. A. Williams, “Pulsed Methylprednisolone in Active Early Rheumatoid Disease: A Dose-Ranging Study,” British Journal of Rheumatology, Vol. 27, No. 3, 1988, pp. 211-214.
http://dx.doi.org/10.1093/rheumatology/27.3.211

  
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