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Pulse therapy with oral prednisone holds no treatment advantage for idiopathic orbital inflammation

Br J Ophthalmol. 2011;95(8):1068-1071.

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Intravenous methylprednisolone pulse therapy combined with oral prednisone held no significant advantage over oral prednisone alone for treating severe idiopathic orbital inflammation, according to a study.

In contrast to what the authors expected, there was no difference found regarding shortened treatment duration, lower cumulative dose or decrease in persistent symptoms in 15 patients with idiopathic orbital inflammation given oral prednisone (OP) only or 12 patients given intravenous methylprednisolone pulse therapy plus oral prednisone (IVMP+OP). The IVMP+OP regimen has been beneficial in other types of orbital inflammatory disease, the authors said.

The IVMP+OP group had a median treatment duration of 160 days; median duration for OP-only was 110 days. In the IVMP+OP group, 73% of patients were symptom-free after treatment; in OP-only patients, 87% were symptom-free. There were no complications related to prednisone therapy.

“IVMP+OP did not result in a shorter duration of prednisone therapy or a difference in symptom-free outcome or recurrence rate compared to OP-only treatment,” the study authors said. The authors suggested that “the short-term positive effect of using IVMP+OP in the treatment of [idiopathic orbital inflammation] is canceled out because of the often prolonged duration of prednisone treatment due to the chronicity of the disease.”