From the Guidelines
For pediatric patients with lupus flare-ups requiring emergency treatment, intravenous methylprednisolone is typically dosed at 30 mg/kg/day (maximum 1000 mg per dose) administered once daily for 3 consecutive days, as recommended by recent guidelines 1. The medication should be infused slowly over 60-90 minutes to minimize side effects.
- After completing the pulse therapy, patients should transition to oral prednisone at 1-2 mg/kg/day (maximum 60 mg/day), with a gradual taper based on clinical response.
- During treatment, monitor vital signs, blood glucose, electrolytes, and blood pressure as methylprednisolone can cause hypertension, hyperglycemia, and electrolyte disturbances.
- Patients should also receive gastrointestinal prophylaxis with a proton pump inhibitor or H2 blocker while on high-dose steroids. This aggressive immunosuppressive approach works by rapidly suppressing the inflammatory cascade and autoimmune activity that characterizes lupus flares, providing quick relief of symptoms while preventing organ damage. The treatment should be administered in conjunction with other supportive care measures based on the specific organ systems affected by the lupus flare, considering issues relevant to the pediatric population, such as dose adjustment, growth, fertility, and psychosocial factors 1. In pediatric patients, the dose of methylprednisolone is recommended to be 1–1.5 mg/kg/day up to a maximum of 60 mg, as stated in guidelines for other conditions 1, but for lupus, the dose is higher, at 30 mg/kg/day (maximum 1000 mg per dose) 1. It is essential to note that the treatment of lupus nephritis in pediatric patients should be comanaged by pediatric nephrologists and rheumatologists with expertise in lupus, and the expertise of other professionals, such as clinical psychologists, psychiatrists, or social workers, can be helpful 1.
From the FDA Drug Label
In pediatric patients, the initial dose of methylprednisolone may vary depending on the specific disease entity being treated. The range of initial doses is 0.11 mg/kg/day to 1.6 mg/kg/day in three or four divided doses When high dose therapy is desired, the recommended dose of methylprednisolone sodium succinate for injection is 30 mg/kg administered intravenously over at least 30 minutes.
For a Lupus flare-up in the emergency department, the recommended IV methylprednisolone dosage for pediatrics is 30 mg/kg administered intravenously over at least 30 minutes 2.
From the Research
IV Methylprednisolone Dosage for Pediatrics in Lupus Flare Ups
- The ideal dosage of IV methylprednisolone for pediatric patients experiencing lupus flare ups is not explicitly stated in the provided studies 3, 4, 5, 6, 7.
- However, the studies suggest that low-dose pulse methylprednisolone can be effective in treating systemic lupus erythematosus (SLE) flares with decreased risk of infectious complications 6.
- A study from 2002 found that using a low dose methylprednisolone pulse (< or = 1500 mg over 3 days) was effective and associated with fewer serious infections 6.
- Another study from 2017 used pulses of 125mg of methyl-prednisolone with each fortnightly pulse of cyclophosphamide and prednisone ≤30mg/day, which improved the outcome of class III, IV and V lupus nephritis 7.
- It is essential to note that the dosage and treatment protocol may vary depending on the specific patient and the severity of the lupus flare up, and should be determined by a healthcare professional 3, 4, 5.
Treatment Considerations
- The management of SLE should aim at preventing organ damage accrual and drug-associated harms, improving health-related quality of life and prolonging survival 4.
- A multidisciplinary approach is necessary due to the complexity of lupus in pediatric patients 5.
- The use of methylprednisolone pulses for moderate-severe flares, followed by low-moderate doses of oral prednisone with quick tapering to maintenance doses of ≤5 mg/day, is recommended 4.