Intravenous methylprednisolone (IVHDM) has few adverse effects and a “relatively acceptable safety profile” in pediatric patients, according to a study published in Clinical Ophthalmology

The retrospective study examined 14 pediatric patients (aged 16 years or younger, mean age 11.9 years, 50% girls) with severe or refractory noninfectious pediatric uveitis. All participants received IVHDM for at least 3 months. Infusions of at least 500 mg of methylprednisolone per day were administered for 1-3 days per month for at least 3 months. Adverse events (AE) were recorded as any laboratory or clinical abnormalities during, or 3 months after, treatment. 

The treatments lasted an average of 14.2 months. All but 1 participant received immunomodulatory therapy (IMT) in addition to IVHDM. Bradycardia, compression fracture, and compression fracture following minor trauma were major AEs identified in 2 participants. Other minor AEs were identified, but none require medical intervention. 


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Researchers report a strong correlation between number of AEs and duration of treatment (P =.004) and a moderate correlation between number of AEs and cumulative dose and weight (P =.07 and P =.051, respectively). Weight gain is not correlated to duration of treatment or cumulative dose but is correlated to the use of additional oral steroids, according to the investigators..

Researchers attribute the weight gain documented in this study to the use of topical steroids in addition to IVHDM as results remain significant after controlling for confounding variables. Additionally, only 2 of the 14 participants experienced major AEs, or side effects, and 1 of these cases was influenced by additional oral steroids. 

This study is limited in its retrospective nature because of possible unsuspected confounding variables and the influence of other medications and underlying conditions. Another limitation is the small sample size of 14 participants, restricting the generalization of results. Additionally, growth retardation was not assessed because of the short follow up window. 

Disclosure: Multiple study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Ghoraba HH, Matsumiya W, Khojasteh H, et al. Safety of intravenous methylprednisolone in refractory and severe pediatric uveitis. Clin Ophthalmol. 2022;16:1697-1706. doi:10.2147/opth.s366370