Long term efficacy of high-dose intravenous methylprednisolone pulses in active lupus nephritis. A 21-month prospective study.
The efficacy of a single course of three high dose intravenous (i.v.) methylprednisolone (MP) pulses followed by low dose oral prednisone (PRED) was assessed in a group of patients with active lupus nephritis (LN). At 21 months after such therapeutic regimen in 10 out of 12 patients a complete clinical remission was found, in one patient a partial response with persistent moderate renal failure occurred, while one patient was refractory even to the additional administration of cyclophosphamide. The statistical analysis of repeated measures of a series of biological markers of LN, monitored over the course of the study, evidenced a significant improvement of serum creatinine (p < 0.05), C3 and C4 complement components (p < 0.05), 24-hour proteinuria (p < 0.02) and ESR values (p < 0.05). Moreover, a progressive and significant reduction of mean daily PRED dosage was reported (p < 0.05). We conclude that i.v. MP pulse therapy may exert a substantial long-term control of active LN and may induce steroid-sparing effects.
Bertoni
M
M
Division of Allergology and Clinical Immunology, University of Florence, Italy.
Brugnolo
F
F
Bertoni
E
E
Salvadori
M
M
Romagnani
S
S
Emmi
L
L
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D003176:Complement C3 / Q000032:analysis; D003181:Complement C4 / Q000032:analysis; D003404:Creatinine / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008181:Lupus Nephritis / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000627:therapeutic use; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D011446:Prospective Studies; D011673:Pulsatile Flow; D013997:Time Factors; D016896:Treatment Outcome
D003176:Complement C3; D003181:Complement C4; D003404:Creatinine; D011241:Prednisone; D008775:Methylprednisolone