Is It Time to Switch to Low Dose Pulsed Methylprednisolone for Treatment of Flares in Systemic Lupus Erythematosus?

Abstract

Background: Methylprednisolone (MP) therapy has gained popularity in clinical practise since its introduction in systemic lupus erythematous (SLE) treatment. Aim of the work: To compare between ‘high dose’ and ‘low dose’ pulsed MP in treatment of acute flares in SLE in terms of efficacy and adverse events. Patients and methods: The records of 473 SLE patients with an indication of pulse MP therapy were retrospectively analysed. Patients were divided into 2 groups where the ‘high dose’ group patients received 3-5 grams (gms) and the ‘low dose’ group patients received 1-1.5 gms. Both groups were compared in terms of efficacy assessed through percentage reduction of Systemic lupus eryhthematosus-2000 (SLEDAI-2K) score and cumulative doses of prednisolone; adverse events and mortality. Results: The study included 430 (92.4%) females and 43 (8.6%) males whose mean age was 28.13±8.2 years. The percentage decline in SLEDAI-2K 3 months after MP therapy was higher in the ‘low dose’ group (p=0.03) whereas percentage reduction of SLEDAI-2K was comparable in both groups 1 and 6 months after therapy (p=0.067, 0.184 respectively). Patients in the ‘high dose’ group received higher cumulative doses of oral prednisolone at 3 and 6 months following pulsed therapy (p<0.001). A higher incidence of adverse events, particularly infections (p<0.001) were recorded in the high dose group. Mortality over 6 months following treatment was comparable (p=0.09). Conclusion: Low dose pulsed MP therapy is equally efficacious to ‘high dose’ regimen yet with a lower incidence of adverse events.