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

Low-dose pulse methylprednisolone for systemic lupus erythematosus flares is efficacious and has a decreased risk of infectious complications
Low-dose pulse methylprednisolone for systemic lupus erythematosus flares is efficacious and has a decreased risk of infectious complications
We sought to test our clinical impression that using a low dose methylprednisolone pulse (MEP; 1500mg 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 1-1.5g and a 'high dose' group of 29 patients who received 3-5g 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 (<20g/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.
infection, lupus erythematosus, systemic, methylprednisolone, mortality, serum albumin
508-513
Badsha, H.
c68de22c-961c-42f3-8795-48de207c6695
Kong, K.O.
b6a371c4-7c82-4002-a20c-971dbf478c3f
Lian, T.Y.
c0605237-001f-43b5-929e-e895b96311fd
Chan, S.P.
83efdf11-1cbf-4f4e-97c6-854c5a80f6d6
Edwards, C.J.
dcb27fec-75ea-4575-a844-3588bcf14106
Chng, H.H.
09ae46f9-8c9b-4334-84b1-787f80db7f22
Badsha, H.
c68de22c-961c-42f3-8795-48de207c6695
Kong, K.O.
b6a371c4-7c82-4002-a20c-971dbf478c3f
Lian, T.Y.
c0605237-001f-43b5-929e-e895b96311fd
Chan, S.P.
83efdf11-1cbf-4f4e-97c6-854c5a80f6d6
Edwards, C.J.
dcb27fec-75ea-4575-a844-3588bcf14106
Chng, H.H.
09ae46f9-8c9b-4334-84b1-787f80db7f22

Badsha, H., Kong, K.O., Lian, T.Y., Chan, S.P., Edwards, C.J. and Chng, H.H. (2002) Low-dose pulse methylprednisolone for systemic lupus erythematosus flares is efficacious and has a decreased risk of infectious complications. Lupus, 11 (8), 508-513.

Record type: Article

Abstract

We sought to test our clinical impression that using a low dose methylprednisolone pulse (MEP; 1500mg 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 1-1.5g and a 'high dose' group of 29 patients who received 3-5g 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 (<20g/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.

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More information

Published date: 2002
Keywords: infection, lupus erythematosus, systemic, methylprednisolone, mortality, serum albumin

Identifiers

Local EPrints ID: 25210
URI: http://eprints.soton.ac.uk/id/eprint/25210
PURE UUID: 11bb44c3-7c95-4441-935e-46b029a9b665

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Date deposited: 07 Apr 2006
Last modified: 15 Jul 2019 19:16

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