title: Corticosteroid Dosing in Pediatric Acute Severe Ulcerative Colitis: A Propensity Score Analysis.
abstract: We aimed to explore the optimal dosing of intravenous-corticosteroids (IVCS) using a robust statistical method on the largest pediatric cohort of acute severe colitis to date.
  
  
  
  Two hundred eighty-three children treated with IVCS for ulcerative colitis were included and studied for 1 year (46% boys, age 12.1 ± 3.9 years, disease duration 2 (interquartile range [IQR] 0-14) months, baseline Pediatric Ulcerative Colitis Activity Index 69 ± 13 points). Confounding by indication was addressed by matching high- and low-IVCS dose patients according to the propensity score method, using 3 cutoffs (1 mg · kg · methylprednisolone to 40 mg · day, 1.25 mg · kg to 50 mg · day and 2 mg · kg to 80 mg · day).
  
  
  
  The median IVCS dose in the entire cohort was 1.0 mg · kg · day (IQR 0.8-1.4) and 44 mg · kg · day (32-60). Ninety-four of 283 children were matched in the low-dose cutoff (1 mg · kg · day), 218 of 283 were matched in the middle cutoff (1.25 mg · kg · day), and 86/283 in the high dose cutoff (2 mg · kg · day). No differences were found in 25 pretreatment baseline variables in the three cutoffs, implying successful matching. There were no statistical differences in the outcomes of the two lower cutoffs (including need for salvage therapy during admission and by 1 years, admission duration, and day-5 Pediatric Ulcerative Colitis Activity Index<35 points; all P > 0.05). In the high cutoff, the higher doses were somewhat better but this benefit reversed in a sensitivity analysis excluding one center. High doses were not associated with better outcome also in a propensity score-weighted regression model on the entire cohort.
  
  
  
  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.
authors.affiliation: *The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center†The Hebrew University of Jerusalem, Jerusalem, Israel‡Alder Hey Children's NHS Foundation Trust, Liverpool, UK§Children's Hospital of Eastern Ontario IBD Centre and Department of Pediatrics, University of Ottawa, Ottawa, Canada||Connecticut Children's Medical Center, Hartford, CT¶Hasbro Chidren's Hospital/Rhode Island Hospital, Alpert School of Medicine at Brown University, Providence#SickKids Hospital, University of Toronto, Toronto, Canada.
authors.forename: Sapir
authors.initials: S
authors.lastname: Choshen
authors.forename: Helen
authors.initials: H
authors.lastname: Finnamore
authors.forename: Marcus K H
authors.initials: MK
authors.lastname: Auth
authors.forename: Tali
authors.initials: T
authors.lastname: Bdolah-Abram
authors.forename: Eyal
authors.initials: E
authors.lastname: Shteyer
authors.forename: David
authors.initials: D
authors.lastname: Mack
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hyams
authors.forename: Neal
authors.initials: N
authors.lastname: Leleiko
authors.forename: Anne
authors.initials: A
authors.lastname: Griffiths
authors.forename: Dan
authors.initials: D
authors.lastname: Turner
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000473:pathology; D016208:Databases, Factual; D004305:Dose-Response Relationship, Drug; D005060:Europe; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007557:Israel; D008297:Male; D009656:North America; D057216:Propensity Score; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids