title: Clinical Experience of Use of High-dose Intravenous Methylprednisolone in Children With Acute Moderate to Severe Colitis.
abstract: Treatment of acute severe colitis (ASC) has been associated with high morbidity and high colectomy rate in children. In the prebiologics era, our centre used short-term high-dose intravenous corticosteroids (IVCS) at 2 to 30 mg · kg · day. We conducted a retrospective review to compare efficacy of different dosing regimes of IVCS.
  
  
  
  Thirty-four children treated with IVCS for ASC were included over 8 years. Patients were studied as 2 groups with similar pretreatment patient characteristics. Group 1 (standard dose) received IVCS at 2 mg · kg · day and group 2 (high dose) received IVCS at 10 to 30 mg · kg · day. Safety, efficacy, and follow-up of the entire cohort for >1 year were studied. The median IVCS dose in the standard- and high-dose cohort was 1.5 mg · kg · day (maximum 60 mg · kg · day) and 24.8 mg · kg · day (maximum 1000 mg · kg · day), respectively.
  
  
  
  Pediatric Ulcerative Colitis Activity Index scores at day 5 were significantly lower in high-dose (15, interquartile range 8.5-20) than in standard-dose IVCS (30, interquartile range 20-30). IVCS side effects were minor and reversible. Overall, medical salvage therapy was required in 5.8% (2 children) before discharge, and in 17% (6 children) at follow-up after 1 year. The colectomy rate of the entire cohort was remarkably low with 0% during admission and 11% (4 children) after 1 year, with a trend of less colectomies in high-dose (4.8%-1 child) than in standard-dose (23%-3 children).
  
  
  
  Our data show that in paediatric ASC, the short-term use of high-dose IVCS is safe and effective. Prospective studies are needed to define the role of IVCS within salvage therapy protocols.
authors.affiliation: *Department of Paediatric Gastroenterology, Hepatology and Nutrition, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool†Antigen Presentation Research Group, Imperial College London, Northwick Park and St Mark's Campus‡London North West Healthcare NHS Trust, St Mark's Campus, Harrow, UK.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Vora
authors.forename: Helen E
authors.initials: HE
authors.lastname: Finnamore
authors.forename: Kay
authors.initials: K
authors.lastname: Crook
authors.forename: Colin
authors.initials: C
authors.lastname: Baillie
authors.forename: Emma
authors.initials: E
authors.lastname: Whittle
authors.forename: Balaji
authors.initials: B
authors.lastname: Krishnamurthy
authors.forename: Krishnappa
authors.initials: K
authors.lastname: Venkatesh
authors.forename: Marcus K H
authors.initials: MK
authors.lastname: Auth
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D003092:Colitis / Q000188:drug therapy* / Q000473:pathology; D004305:Dose-Response Relationship, Drug; D004739:England; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008485:Medical Audit; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone