P531 Intravenous corticosteroid dosing in paediatric acute severe Ulcerative Colitis (ASC): A multicenter propensity score study
D. Turner*1, H. Finnamore2, M.K. Auth3, E. Shteyer1, D. Mack4, J. Hyams5, N. Leleiko6, A.M. Griffiths7, S. Choshen1
1Shaare Zedek Medical Center , Pediatric Gastroenterolgoy, Jerusalem, Israel, 2AldeHey Children’s NHS Foundation Trust, Liverpool, Pediatric Gastroenterolgoy, Liverpool, United Kingdom, 3Alde Hey Children’s NHS Foundation Trust, Liverpool, Pediatric Gastroenterolgoy, Liverpool, United Kingdom, 4CHEO, Pediatric Gastroenterolgoy, Ottawa, Canada, 5Connecticut Children's Medical Center, Hartford, CT, Pediatric Gastroenterolgoy, Hartford, United States, 6Providence, Pediatric Gastroenterolgoy, Providence, United States, 7SickKids, Pediatric Gastroenterolgoy, Toronto, Canada
Data to support dosing of intravenous corticosteroids (IVCS) in pediatric acute severe ulcerative colitis (ASC) are lacking and extrapolated from adult literature. We aimed to explore the optimal dosing of IVCS in pediatric ASC using a robust statistical method on the largest pediatric cohort of ASC to date.
283 children treated with IVCS for UC were included from the retrospective and prospective OSCI studies and newly reviewed patients from Jerusalem and Liverpool. Patients were followed for 1 year (46% males, age 12.1 ± 3.9 years, disease duration 2 (IQR 0-14) months, baseline PUCAI 69 ± 13 points). Confounding by indication was addressed by matching high and low IVCS dose patients according to the propensity score (PS) method, using 3 cutoff doses (1mg/kg methylprednisolone to 40mg/day, 1.25mg/kg to 50mg/day and 2mg/kg to 80mg/day).
The median IVCS dose in the entire cohort was 1.0 mg/kg (IQR 0.8-1.4) and 44 mg/day (32-60). 218 children were matched in the 1.25mg/kg cutoff, 94 children were matched in the 1mg/kg cutoff and 86 children were matched in the 2mg/kg cutoff. No differences were found in 25 pre-treatment baseline variables in the three cutoffs, implying successful matching. There were no statistical differences in all outcomes of the two lower cutoffs (including need for salvage therapy during admission and by 1 years, admission duration, day-5 PUCAI< 35 points and day 5 CRP, ESR and albumin; all P >0.05). In the high cutoff, the higher doses were somewhat better but this benefit reversed after excluding one center in a sensitivity analysis that used routinely very high doses and reported better outcomes. In a PS-weighted regression model on the entire cohort, high doses were not associated with better outcome (all P>0.1).
Our data support current guidelines of dosing IVCS in the range of 1-1.5mg/kg/day to a maximum of 40-60mg/day.