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Low-dose pulse methylprednisolone for systemic lupus erythematosus flares is efficacious and has a decreased risk of infectious complications

Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433

K O Kong

T Y Lian

Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433

S P Chan

Clinical Epidemiology Unit, Tan Tock Seng Hospital, Singapore 308433

C J Edwards

H H Chng

Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433

We sought to test our clinical impression that using a low dose methylprednisolone pulse (MEP; µ1500 mg over 3 days) in treating flares of systemic lupus erythematosus (SLE) was effective and associated with fewer serious infections.

We retrospectively studied SLE patients who received MEP between 1989 and 2000. A ‘low dose’ group of 26 patients who had received 1–1.5 g and a ‘high dose’ group of 29 patients who received 3–5 g of MEP were identified. SLEDAI scores and prednisolone doses were recorded at the time of MEP pulses and 6 months later. All serious infections (requiring admission and i.v. antibiotics) occurring during this 6 month period and their outcomes were recorded.

Both groups had similar demographic data, initial SLEDAI scores, i.v. cyclophosphamide use, and SLE organ involvement. Despite high-and low-dose MEP being efficacious in controlling disease activity (lowering of SLEDAI scores and subsequent prednisolone dose) there were only nine episodes of serious infection in seven patients in the low-dose group compared with 20 episodes in 17 patients from the high-dose group (P ^ 0.04). In both groups a majority of infections (75 and 77% in the high-and low-dose groups) occurred in the first month after MEP. Those with a low serum albumin (< 20 g/l) had an increased risk of mortality (OR 44, 90% CI 6.19–312.98) and a trend towards greater numbers of infections.

Low-dose MEP was effective in controlling SLE flares and associated with fewer serious infections than traditional high-dose MEP.

Key Words: infection • lupus erythematosus, systemic • methylprednisolone • mortality • serum albumin

Lupus, Vol. 11, No. 8, 508-513 (2002)
DOI: 10.1191/0961203302lu243oa


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