Background Supra-pharmacological doses of corticosteroids (pulse therapy) are used in various autoimmune disorders. Methylprednisolone and dexamethasone pulse therapy have demonstrated similar efficacy for some diseases; therefore, differences in their adverse effects can help the selection of any of them.
Objectives To evaluate changes in glycemia and blood pressure in patients who received pulse therapy with dexamethasone or methylprednisolone.
Methods We evaluated the charts of patients who received corticosteroid pulse therapy with dexamethasone (200 mg/day) or methylprednisolone (1000 mg/day). We included patients who received at least three days of pulse therapy and who had records of glycemia and blood pressure four times at day. We evaluated the blood pressure and glycemia measurements before the first pulse therapy and the next three-day measurements each six hours. We evaluated through linear mixed models the factors associated with an increase in glycemia or blood pressure (systolic or diastolic) in the program R 3.0.2. For the glycemia analysis we excluded patients with diabetes history and patients having glycemia >180 before the pulse therapy.
Results We included 117 patients, 83 received pulse therapy with methylprednisolone and 34 with dexamethasone. Multivariate mixed models showed a statistically significant increase in glycemia and blood pressure (systolic and diastolic) from the first measurement after the initial dose of pulse therapy (Figure 1); factors associated with hyperglycemia (adjusted for creatinine levels, sex and units of insulin received) were higher glycemia before the pulse therapy (p=0.0016) and the use of methylprednisolone (p=0.0098). Factors associated with an increase of systolic or diastolic blood pressure were: higher blood pressure before the first pulse therapy (p<0.0001) and higher creatinine levels (p=0.0099 and 0.0031) but not the type of corticosteroid (dexamethasone or methylprednisolone).
Conclusions Pulse therapy with methylprednisolone showed a higher increase in glycemia than dexamethasone. Susceptible patients to an increase of glycemia are who have initial hyperglycemia; patients susceptible to an increase in blood pressure are who have elevated serum creatinine levels and who have initial hypertension.
Sinha A, Bagga A. Pulse steroid therapy. Indian J Pediatr 2008;75:1057–66.
Disclosure of Interest None declared
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