Intravenous pulses of methylprednisolone for systemic lupus erythematosus.
BACKGROUND
Intravenous (IV) pulses of methylprednisolone (MEP) commonly are used to treat severe manifestations of systemic lupus erythematosus (SLE). However, despite wide use of this treatment the best dose, timing, and the situations in which this treatment should be used remain largely anecdotal.


OBJECTIVE
To review the mechanisms of action and evidence for clinical use of IV MEP in the treatment of SLE.


METHODS
The literature on MEP use in SLE from 1966 to 2002, using PubMed from the National Library of Medicine, was reviewed.


RESULTS
As with other modes of corticosteroid administration, IV MEP has significant anti-inflammatory and immunosuppressive actions. These actions have been shown to be effective in treating SLE in clinical trials, for lupus nephritis. The studies are mainly uncontrolled and retrospective. Long-term observations from a few double-blind prospective trials suggest that monthly pulses of MEP, in addition to IV cyclophosphamide, may be useful. Pulse MEP is beneficial for several serious manifestations of SLE, such as neuro-psychiatric lupus, pulmonary hemorrhage, severe blood dyscrasias, cardiomyopathy, and vasculitis. However, significant side effects may occur, mostly infections, which are worse in patients with hypoalbuminemia.


CONCLUSIONS
IV pulses of MEP rapidly immunosuppress patients with organ and/or life-threatening manifestations of SLE. However, the gold standard 1 g/day for 3 consecutive days is associated with significant infectious complications and lower doses may be just as useful.
Badsha
Humeira
H
Department of Rheumatology, Tan Tock Seng Hospital, Singapore.
Edwards
Christopher J
CJ
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007275:Injections, Intravenous; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy*; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D039781:PubMed; D020551:Pulse Therapy, Drug
D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone