title: Is high dose intravenous methylprednisolone pulse therapy in patients with Graves' orbitopathy safe?
abstract: High dose intravenous glucocorticoid pulse (i.v. GCS) therapy is a proven approach in patients with active, moderate to severe Graves' orbitopathy (GO) and dysthyroid optic neuropathy (DON). In moderate to severe GO, the European Group on Graves' Orbitopathy (EUGOGO) recommends a 12-week course of intravenous methylprednisolone (i.v. MP) pulse therapy with a cumulative dose of 4.5 g. The response rate of i.v. GCS treatment is significantly higher than oral glucocorticoid (oral GCS) therapy and is associated with fewer adverse events. However, a major concern was raised because of reports of fatal side effects which may be associated with this therapy, especially when single and cumulative doses of methylprednisolone (MP) are higher than recommended. The prevalence and severity of adverse effects during treatment have not been fully described. The aim of this review was to summarise the frequency of major adverse effects of i.v. GCS compared to oral GCS and attempt to propose some practical suggestions as to how to monitor and prevent the development of side effects.
authors.affiliation: Department of Internal Medicine and Endocrinology, Medical University of Warsaw. piotr.miskiewicz@wum.edu.pl.
authors.forename: Piotr
authors.initials: P
authors.lastname: Miśkiewicz
authors.forename: Adrianna
authors.initials: A
authors.lastname: Kryczka
authors.forename: Urszula
authors.initials: U
authors.lastname: Ambroziak
authors.forename: Beata
authors.initials: B
authors.lastname: Rutkowska
authors.forename: Renata
authors.initials: R
authors.lastname: Główczyńska
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Opolski
authors.forename: George
authors.initials: G
authors.lastname: Kahaly
authors.forename: Tomasz
authors.initials: T
authors.lastname: Bednarczuk
mesh_terms: D061605:Administration, Intravenous; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D049970:Graves Ophthalmopathy / Q000188:drug therapy*; D006801:Humans; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000009:adverse effects*; D009915:Orbit / Q000187:drug effects* / Q000473:pathology; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone