Efficacy and Safety of Pulse Steroid Therapy in Japanese Pediatric Patients with Ulcerative Colitis: A Survey of the Japanese Society for Pediatric Inflammatory Bowel Disease

Abstract

Aims: We have evaluated the therapeutic efficacy and safety of pulse steroid therapy for ulcerative colitis (UC) in a Japanese pediatric population by means of a survey. Methods: A questionnaire on UC patients treated with therapy between 2002 and 2006 was sent to 37 members of the Japanese Society for Pediatric Inflammatory Bowel Disease. Results: 21 of 62 cases in 6 of 19 centers registered in this study had been treated with pulse steroid therapy. The success rate of remission induction with this treatment was 55%, and improvement was observed in all cases in which remission was not achieved. There were no reports of any obvious side effects. The most common reason for using pulse steroid therapy was for remission induction in relapsed cases. Over the course of 12 (or fewer) months, the number of cases in which remission was maintained was only 1 in 4. However, the amount of concomitant steroid use had significantly decreased after 1 year. Conclusions: This survey shows that in Japan, pulse steroid therapy is used for a relatively large number of children with UC and is as an effective method of remission induction that has few side effects.

Management of Paediatric Ulcerative Colitis, Part 2

“…Nonetheless, some case series suggested a benefit to higher and even pulse doses (161)(162)(163) while others did not (164,165). It could be concluded that the vast majority of evidence suggests that 40 mg is not less effective than higher doses in ASC but, given the few anecdotal reports and the severity of ASC, it is not unreasonable to dose higher in selected patients for several days until response has been achieved.…”

“…Higher doses were also not justified according to a recent propensity score analysis in a large pediatric cohort of ASC (including among others the children from the OSCI study) (160) and, in a retrospective study among children with ASC, the dose of corticosteroids within the standard range was not different between those who responded and those who failed IVCS (9). Nonetheless, some case series suggested a benefit to higher and even pulse doses (161)(162)(163) while others did not (164,165). It could be concluded that the majority of evidence suggests that 40 mg is not less effective than higher doses in ASC but, given the few anecdotal reports and the severity of ASC, it is not unreasonable to dose higher in selected patients for several days until response has been achieved.…”

Corticosteroid Dosing in Pediatric Acute Severe Ulcerative Colitis

“…A total of 283 children were eligible and included in the study (Table 1), of whom 127 (45%) had at most mild disease by day 5 of admission (ie, PUCAI < 35); 89 (31%) had failed IVCS and required salvage therapy during the admission after a median of 12 (8)(9)(10)(11)(12)(13)(14)(15)(16) days. The overall colectomy rate by discharge was 20% (n ¼ 57), and the median admission duration was 9 days (IQR [6][7][8][9][10][11][12][13][14][15][16][17][18][19]. By 1 year after discharge, 122 children (43%) required salvage medical therapy, of whom 89 (31% of the entire cohort) required colectomy.…”

Pulse steroids as induction therapy for children with ulcerative colitis

“…reported that pulse steroid therapy was used for a relatively large number of children with UC in Japan, and it was used as a method of remission induction, which had few side‐effects and was shown to be effective. They described the success rate of remission induction with this treatment as 55%; improvement was observed in all cases in which remission was not achieved, and there were no reports of any obvious side‐effects 19 …”

“…They described the success rate of remission induction with this treatment as 55%; improvement was observed in all cases in which remission was not achieved, and there were no reports of any obvious side-effects. 19 The serum pharmacokinetics of methylprednisolone in pulse steroid therapy seemed to be different from that of orally administrated prednisolone. The half-life of orally and intravenously given prednisolone in the standard way has been reported to be 2.7-3.7 h independent from their doses in the previous studies.…”