Controlled clinical trial of IV cyclophosphamide versus IV methylprednisolone in severe neurological manifestations in systemic lupus erythematosus.
BACKGROUND
Severe neurological involvement in systemic lupus erythematosus (NPSLE) is one of the most dreadful complications of the disease.


OBJECTIVE
To identify the best drug, dose, and treatment.


METHODS
The study was a controlled clinical trial at two tertiary care centres of patients with SLE according to the ACR criteria, with incident (no more than 15 days) onset of severe NP manifestations such as seizures, optic neuritis, peripheral or cranial neuropathy, coma, brainstem disease, or transverse myelitis. Induction treatment with 3 g of IV methylprednisolone (MP) followed by either IV monthly cyclophosphamide (Cy) versus IV MP bimonthly every 4 months for 1 year and then IV Cy or IV MP every 3 months for another year. The primary end point was response to treatment: at least 20% improvement from basal conditions on clinical, laboratory, or specific neurological testing variables.


RESULTS
Overall, a response rate of 75% was observed. Of the 32 patients studied, 18/19 receiving Cy and 7/13 receiving MP responded to treatment (p<0.03).


CONCLUSIONS
Cy seems to be more effective than MP in the treatment of acute, severe NPSLE.
Barile-Fabris
L
L
Clinical Epidemiology Research Unit, Hospital Espicialidades, Centro Médico Nacional Instituto Mexicano del Seguro Social, Mexico. lbarile@prodigy.net.mx
Ariza-Andraca
R
R
Olguín-Ortega
L
L
Jara
L J
LJ
Fraga-Mouret
A
A
Miranda-Limón
J M
JM
Fuentes de la Mata
J
J
Clark
P
P
Vargas
F
F
Alocer-Varela
J
J
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D020945:Lupus Vasculitis, Central Nervous System / Q000188:drug therapy*; D008775:Methylprednisolone / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D008775:Methylprednisolone