Corticosteroid Dosing in Pediatric Acute Severe Ulcerative Colitis

Choshen, Sapir; Finnamore, Helen; Auth, Marcus K.H.; Bdolah‐Abram, Tali; Shteyer, Eyal; Mack, David R.; Hyams, Jeffrey S.; Leleiko, Neal S.; Griffiths, Anne M.; Turner, Dan

doi:10.1097/mpg.0000000000001079

Cited by 14 publications

(10 citation statements)

References 39 publications

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“…Although a meta-regression analysis failed to show a relationship between dose and colectomy rate above the equivalent of 60 mg methylprednisolone,106 400 mg hydrocortisone is equivalent to 80 mg methylprednisolone. In children and adolescents, a dose of 1–1.5 mg/kg/day up to a maximum of 60 mg is recommended 208…”

Section: Ulcerative Colitismentioning

confidence: 99%

British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults

Lamb

Kennedy

Raine

et al. 2019

Gut

1,641

1,816

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Ulcerative colitis and Crohn’s disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn’s and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn’s disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn’s disease, including patients, their families and friends.

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Section: Ulcerative Colitismentioning

confidence: 99%

British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults

Lamb

Kennedy

Raine

et al. 2019

Gut

1,641

1,816

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“…In 2 pediatric inception cohorts, the occurrence of ASC was associated with an increased risk of colectomy (7,8). The advent of calcineurin inhibitors and infliximab has reduced the short-term colectomy rate from between 40% to 70% (9,(11)(12)(13) to approximately 10% to 20% in children (10,14,15) and the 1-year colectomy rate from $60% (9,16) to between 18% to 22% (10,14,16). Among those who fail IVCS treatment, roughly 50% to 60% of responders to salvage medical therapy will require colectomy within 1 to 2 years (10,14).…”

Section: Introductionmentioning

confidence: 99%

Management of Paediatric Ulcerative Colitis, Part 2

Turner

Ruemmele

Orlanski-Meyer

et al. 2018

J. pediatr. gastroenterol. nutr.

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180

194

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“…A rapid decreased in methylprednisolone to 1 mg/kg/d (40 mg/d) should be employed once response has been observed. Higher doses were not justified according to a recent propensity score analysis in a large pediatric cohort of acute severe colitis [110].…”

Section: Gastrointestinal Disordersmentioning

confidence: 99%

Clinical Use and Molecular Action of Corticosteroids in the Pediatric Age

Ferrara

Petrillo

Giani

et al. 2019

IJMS

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Corticosteroids are the mainstay of therapy for many pediatric disorders and sometimes are life-saving. Both endogenous and synthetic derivatives diffuse across the cell membrane and, by binding to their cognate glucocorticoid receptor, modulate a variety of physiological functions, such as glucose metabolism, immune homeostasis, organ development, and the endocrine system. However, despite their proved and known efficacy, corticosteroids show a lot of side effects, among which growth retardation is of particular concern and specific for pediatric age. The aim of this review is to discuss the mechanism of action of corticosteroids, and how their genomic effects have both beneficial and adverse consequences. We will focus on the use of corticosteroids in different pediatric subspecialties and most common diseases, analyzing the most recent evidence.

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Corticosteroid Dosing in Pediatric Acute Severe Ulcerative Colitis

Abstract: Our data support present guidelines that doses of IVCS >1 to 1.5 mg · kg · day (maximum 40-60 mg · kg · day) are not justified in acute severe colitis.

Cited by 14 publications

References 39 publications

British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults

British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults

Management of Paediatric Ulcerative Colitis, Part 2

Clinical Use and Molecular Action of Corticosteroids in the Pediatric Age

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