open access

Vol 65, No 5 (2014)
Postgraduate education
Published online: 2014-10-09
Submitted: 2014-06-10
Accepted: 2014-07-03
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Is high dose intravenous methylprednisolone pulse therapy in patients with Graves’ orbitopathy safe?

Piotr Miśkiewicz, Adrianna Kryczka, Urszula Ambroziak, Beata Rutkowska, Renata Główczyńska, Grzegorz Opolski, George Kahaly, Tomasz Bednarczuk
DOI: 10.5603/EP.2014.0056
·
Endokrynologia Polska 2014;65(5):402-413.

open access

Vol 65, No 5 (2014)
Postgraduate education
Published online: 2014-10-09
Submitted: 2014-06-10
Accepted: 2014-07-03

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. (Endokrynol Pol 2014; 65 (5): 402–413)

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. (Endokrynol Pol 2014; 65 (5): 402–413)

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Keywords

methylprednisolone, glucocorticoids; Graves’ disease; Graves’ orbitopathy; management of Graves’ orbitopathy; adverse events; side effects

About this article
Title

Is high dose intravenous methylprednisolone pulse therapy in patients with Graves’ orbitopathy safe?

Journal

Endokrynologia Polska

Issue

Vol 65, No 5 (2014)

Pages

402-413

Published online

2014-10-09

DOI

10.5603/EP.2014.0056

Bibliographic record

Endokrynologia Polska 2014;65(5):402-413.

Keywords

methylprednisolone
glucocorticoids
Graves’ disease
Graves’ orbitopathy
management of Graves’ orbitopathy
adverse events
side effects

Authors

Piotr Miśkiewicz
Adrianna Kryczka
Urszula Ambroziak
Beata Rutkowska
Renata Główczyńska
Grzegorz Opolski
George Kahaly
Tomasz Bednarczuk

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