Pulse steroids as induction therapy for children with ulcerative colitis

Abstract

These findings suggest that pulse steroid therapy is an option to be considered in children with moderate-to-severe UC.

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.…”

Corticosteroid Dosing in Pediatric Acute Severe Ulcerative Colitis

“…A prospective study of 20 patients treated with pulse steroids showed remission rates of only 60%, similar to the rates found in local historical controls (10). A retrospective Japanese report found that pulse dosing in 20 children achieved remission faster than in 17 children treated with standard dosing; however, treatment was successful in all 37 children and none required salvage therapy (9)(10)(11). A national survey from Japan showed 55% short-term remission among 21 children treated with pulse steroid therapy; the comparative results of the other 41 children treated with the traditional dosing are not reported (11).…”

“…None of the following outcomes were significantly different between the low-and high-dose groups: the need for salvage therapy during admission (30% vs 31%; P ¼ 0.88), rates of PUCAI < 35 points at day 5 (44% vs 40%; P ¼ 0.68), median admission days (9)(10)(11)(12)(13)(14)(15)(16)(17)(18) vs 10 [6-21]; P ¼ 0.27), and the need for salvage therapy during the year after admission (47% vs 38%; P ¼ 0.22) (Fig. 4).…”

“…We used the ''doubly robust'' PS-weighting technique on the entire cohort, using the standard cutoff, the unbalanced baseline variables, and the 3 clinically important variables. The only significantly different outcome was the length of admission with a clinically irrelevant effect size (median of 9 days (IQR 5-16) in the low-dose group vs 10 days (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) in the high-dose group, P ¼ 0.005). The need for salvage therapy during admission (OR ¼ 1.0 (95% CI ¼ 0.6-1.5); P ¼ 0.92), rates of PUCAI < 35 points at day 5 (OR ¼ 1.2 (0.8-1.8); P ¼ 0.42), and the need for salvage therapy during the year after admission (OR ¼ 1.3 (0.9-2.0); P ¼ 0.18) were similar.…”

Ulcerative Colitis in Children and Adolescents

“…Methylprednisolone has the advantage of less mineralocorticoid effects. One study from Japan has evaluated pulse steroid therapy in children with UC (Kudo et al 2011). This group retrospectively compared outcomes from children with UC treated with conventional methylprednisolone dosing to another group treated with megadose pulse therapy (20-30 mg/kg/day, to max of 1000 mg).…”